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Sample records for arthroplasty preliminary study

  1. Initial Stability of Subtrochanteric Oblique Osteotomy in Uncemented Total Hip Arthroplasty: A Preliminary Finite Element Study

    PubMed Central

    Li, Liangtao; Yu, Mingyang; Ma, Renshi; Zhu, Dong; Gu, Guishan

    2015-01-01

    Background Subtrochanteric oblique osteotomy (SOO) has been widely used to reconstruct highly dislocated hips in uncemented total hip arthroplasty. The occurrence of complications can be attributed to the instability of the osteotomy region. The aim of this study was to evaluate the initial stability of SOO in uncemented total hip arthroplasty. Material/Methods A 3-dimensional finite element femur-stem model was created, and a virtual SOO was performed at 4 oblique angles: 30°, 45°, 60°, and 90°. The von Mises stress distribution in the femur-stem complex and the displacement under different oblique angles were evaluated in the SOO models, in comparison with that of the intact model. Results The study demonstrated that the distal fragment of the femur bore more stresses than the proximal fragment, and the maximum stress was concentrated in the femoral neck and the cortical bone, which contacted with the distal end of the stem. SOO increased the stress of both the femur and the stem, and fractures may occur in the stress concentration sites. Additionally, comparing the displacement at different oblique angles, the lateral region was larger than that of the medial region on the subtrochanteric osteotomy plane. The minimum micromotion on the osteotomy plane was obtained when the oblique angle was 45°. Conclusions The fit and fill of the distal fragment of the femur and the stem is essential for the stability of the subtrochanteric osteotomy region. The optimal oblique angle for SOO appears to be 45°. PMID:26153071

  2. Single-blinded, randomised preliminary study evaluating the effects of 2 Hz electroacupuncture for postoperative pain in patients with total knee arthroplasty

    PubMed Central

    Tzeng, Chung-Yuh; Chang, Shih-Liang; Wu, Chih-Cheng; Chang, Chu-Ling; Chen, Wen-Gii; Tong, Kwok-Man; Huang, Kui-Chou; Hsieh, Ching-Liang

    2015-01-01

    Objective To explore the point-specific clinical effect of 2 Hz electroacupuncture (EA) in treating postoperative pain in patients undergoing total knee arthroplasty (TKA), Methods In a randomised, partially single-blinded preliminary study, 47patients with TKA were randomly divided into three groups: control group (CG, n=17) using only patient-controlled analgesia (PCA); EA group (EAG, n=16) with 2 Hz EA applied at ST36 (Zusanli) and GB34 (Yanglingquan) contralateral to the operated leg for 30 min on the first two postoperative days, also receiving PCA; and non-point group (NPG, n=14), with EA identical to the EAG except given 1 cm lateral to both ST36 and GB34. The Mann–Whitney test was used to show the difference between two groups and the Kruskal–Wallis test to show the difference between the three groups. Results The time until patients first required PCA in the CG was 34.1±22.0 min, which was significantly shorter than the 92.0±82.7 min in the EAG (p<0.001) and 90.7±94.8 min in the NPG (p<0.001); there was no difference between the EAG and NPG groups (p>0.05). The total dosage of PCA solution given was 4.6±0.9 mL/kg body weight in the CG, 4.2±1.0 mL/kg in the EAG and 4.5±1.0 mL/kg in the NPG; there were no significant differences (p>0.05) among the three groups. Conclusions In this small preliminary study, EA retarded the first demand for PCA in comparison with no EA. No effect was seen on the total dosage of PCA required and no point-specific effect was seen. PMID:25910930

  3. A FUNCTIONAL AND ROENTGENOGRAPHIC PRELIMINARY COMPARATIVE STUDY USING METAL-BACKED AND ALL-POLYETHYLENE TIBIAL COMPONENTS IN TOTAL KNEE ARTHROPLASTY

    PubMed Central

    de Andrade, Marco Antônio Percope; dos Santos, Juliano Rodrigues; Gonzaga, Luiz Gustavo Alves; Silva, Guilherme Moreira Abreu e

    2015-01-01

    Objective: To describe and clinically and radiographically compare patients who underwent total knee arthroplasty (TKA) with all-polyethylene (ALP) and metal-backed (MTB) tibial implants. Methods: Patients who underwent TKA between January 1988 and December 2004 were grouped according to the type of implant received: all-polyethylene or metal-backed. Sixty patients came for evaluations, totaling 82 operated knees. Among these, 22 patients had undergone TKA only with ALP (12 unilateral and 10 bilateral cases), 33 patients only with MTB (26 unilateral and 7 bilateral cases) and five patients underwent TKA with ALP in one knee and MTB in the other. The knees were divided thus: group 1, 37 knees with ALP; and group 2, 45 knees with MTB. Results: There were no differences in clinical or functional evaluations between the groups. The mean radiolucency in the femur was 0.838 mm for the patients in group 1 and 0.356 mm for the patients in group 2 (p = 0.049). For the tibia, in the AP view, there was a mean value of 2.703 mm for group 1 and 0.733 mm for group 2 (p = 0.000). In the lateral view, the mean values for osteolysis was 0.405 mm for group 1 and 0.200 mm for group 2 (p = 0.074). Conclusions: There were no differences between the groups in the functional and clinical evaluations. However, greater radiolucency was observed in the arthroplasties with ALP, both in the femur in the lateral view and in the tibia in the AP view. Level of evidence IV – case series study. PMID:27022556

  4. Comparison of 2 Zero-Profile Implants in the Treatment of Single-Level Cervical Spondylotic Myelopathy: A Preliminary Clinical Study of Cervical Disc Arthroplasty versus Fusion

    PubMed Central

    Yang, Li-Li; Liu, Zu-De; Yuan, Wen

    2016-01-01

    Objectives Cervical disc arthroplasty (CDA) with Discover prosthesis or anterior cervical discectomy and fusion (ACDF) with Zero-P cage has been widely used in the treatment of cervical spondylotic myelopathy (CSM). However, little is known about the comparison of the 2 zero-profile implants in the treatment of single-level CSM. The aim was to compare the clinical outcomes and radiographic parameters of CDA with Discover prosthesis and ACDF with Zero-P cage for the treatment of single-level CSM. Methods A total of 128 consecutive patients who underwent 1-level CDA with Discover prosthesis or ACDF with Zero-P cage for single-level CSM between September 2009 and December 2012 were included in this study. Clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) score and Neck Disability Index (NDI). For radiographic assessment, the overall sagittal alignment (OSA), functional spinal unit (FSU) angle, and range of motion (ROM) at the index and adjacent levels were measured before and after surgery. Additionally, the complications were also recorded. Results Both treatments significantly improved all clinical parameters (P < 0.05), without statistically relevant differences between the 2 groups. The OSA and FSU angle increased significantly in both groups (P <0.05). Compared with Zero-P group, ROMs at the index levels were well maintained in the Discover group (P < 0.05). However, there were no statistical differences in the ROMs of adjacent levels between the 2 groups (P > 0.05). Besides, no significant differences existed in dysphagia, subsidence, or adjacent disc degeneration between the 2 groups (P > 0.05). However, significant differences occurred in prosthesis migration in CDA group. Conclusions The results of this study showed that clinical outcomes and radiographic parameters were satisfactory and comparable with the 2 techniques. However, more attention to prosthesis migration of artificial cervical disc should be paid in the

  5. A biomechanical study on fracture risks in ulnohumeral arthroplasty.

    PubMed

    Degreef, I; Van Audekercke, R; Boogmans, T; De Smet, L

    2011-06-01

    In the Outerbridge-Kashiwagi ulnohumeral arthroplasty, bone strength may be weakened significantly as a result of the humeral fenestration. Therefore, fracture risks may be increased, particularly in the immediate postoperative period. The objective of this biomechanical cadaver study is to study the humeral bone strength after ulnohumeral arthroplasty. A biomechanical cadaveric study was done in which differences in force needed to fracture the humerus with and without fenestration was measured. First, the diaphysis of 12 distal humeri was embedded and a posterior force was applied until a fracture occurred. Second, a similar study was done with fixed humeral columns, to specifically compare the column strength. In the first part, the force needed to fracture was reduced by 17% after ulnohumeral arthroplasty, which was not statistically significant. However, a shift in the fracture pattern occurred: from diaphyseal fracture towards column fractures after the arthroplasty. In the second part, the force needed to fracture the columns proved to be significantly reduced by 41% after humeral perforation. Alterations in the biomechanical properties of the distal humerus after ulnohumeral arthroplasty may lead to a shift in fracture patterns from diaphyseal to column fractures. The strength of the columns is strongly reduced by 41%. PMID:21592841

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

    PubMed Central

    Kong, Xiangrong; Jiranek, William A.

    2009-01-01

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

  7. Modular hybrid total hip arthroplasty. Experimental study in dogs

    PubMed Central

    2011-01-01

    Background This prospective experimental study evaluated the surgical procedure and results of modular hybrid total hip arthroplasty in dogs. Methods Ten skeletally mature healthy mongrel dogs with weights varying between 19 and 27 kg were used. Cemented modular femoral stems and uncemented porous-coated acetabular cups were employed. Clinical and radiographic evaluations were performed before surgery and at 30, 60, 90, 120, 180 and 360 days post-operation. Results Excellent weight bearing was noticed in the operated limb in seven dogs. Dislocation followed by loosening of the prosthesis was noticed in two dogs, which were therefore properly treated with a femoral head osteotomy. Femoral fracture occurred in one dog, which was promptly treated with full implant removal and femoral osteosynthesis. Conclusions The canine modular hybrid total hip arthroplasty provided excellent functionality of the operated limb. PMID:21736758

  8. Pain and Function Recovery Trajectories following Revision Hip Arthroplasty: Short-Term Changes and Comparison with Primary Hip Arthroplasty in the ADAPT Cohort Study

    PubMed Central

    Whitehouse, Michael R.; Wylde, Vikki; Gooberman-Hill, Rachael; Blom, Ashley W.

    2016-01-01

    Background and Purpose Patients report similar or better pain and function before revision hip arthroplasty than before primary arthroplasty but worse results are reported after revision surgery than after primary surgery. The trajectory of post-operative recovery during the first months and any differences by type of surgery have received little attention. We explored the trajectories of change in pain and function after revision hip arthroplasty to 12-months post-operatively and compare them with those observed after primary hip arthroplasty. Methods This study is a prospective cohort study of patients undergoing primary (n = 80 with 92% for an indication of osteoarthritis) and revision (n = 43) hip arthroplasties. WOMAC pain and function scores and walking speed were collected pre-operatively, at 3 and 12-months post-operatively. Multilevel regression models were used to chart and compare the trajectories of change (0–3 months and 3–12 months) between types of surgery. Results The improvements in pain and function following revision arthroplasty occurred within the first 3-months with no evidence of further change beyond this initial period. While the pattern of recovery was similar to the one observed after primary arthroplasty, improvements in the first 3-months were smaller after revision compared to primary arthroplasty. Patients listed for revision surgery reported lower pre-operative pain levels but similar post-operative levels compared to those undergoing primary surgery. At 12-months post-operation patients who underwent a revision arthroplasty had not reached the same level of function achieved by those who underwent primary arthroplasty. Conclusion The post-operative improvements in pain and function are larger following primary hip arthroplasty than following revision hip arthroplasty. Irrespectively of surgery type, most of the improvements occur in the first three post-operative months. More research is required to identify whether the recovery

  9. Two Case Studies Related to Total Knee Arthroplasty

    PubMed Central

    Hale, David

    2016-01-01

    Objectives: Report on Two Case Studies related to Total Knee Arthroplasty Previously Discussed by AKS Members Methods: Case Series Case 1: A 76 year old woman requiring a right total knee replacement in the presence of marked dystrophic calcification affecting the quadriceps tendon on a background of having sustained a post operative quadriceps tendon rupture post left TKR in 2013 Case 2: Management issues related to performing a TKR in a 80 year old woman with a possible past history of TB affecting the joint Conclusion: Both procedures went smoothly and particularly as advice was given by AKS members, these are presented largely for feedback.

  10. Pyrocarbon proximal interphalangeal joint arthroplasty: outcomes of a cohort study.

    PubMed

    McGuire, D T; White, C D; Carter, S L; Solomons, M W

    2012-07-01

    Pyrocarbon arthroplasty of the proximal interphalangeal joint is a relatively new concept. Early studies have been encouraging, reporting improved pain and function, but a largely unchanged arc of motion. Subsidence of the implant is common, but how it relates to outcome has not been analyzed. This study was performed to review the results of 57 pyrocarbon proximal interphalangeal implanted joints. Results showed a statistically significant increase in the arc of motion, excellent pain relief, and improved function. Subsidence was observed on radiographs in 40% of joints, but no correlation was found compared with arc of motion or function. The incidence of complications is fairly high and usually related to the peri-articular soft tissues, but they are usually minor and do not require further treatment. From this review, we can recommend the use of this implant for treatment of arthritis of the proximal interphalangeal joint.

  11. Hydrotherapy after total knee arthroplasty. A follow-up study.

    PubMed

    Giaquinto, S; Ciotola, E; Dall'Armi, V; Margutti, F

    2010-01-01

    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.

  12. How does scapula motion change after reverse total shoulder arthroplasty? - a preliminary report

    PubMed Central

    2012-01-01

    Background Arm elevation is composed of glenohumeral and scapulothoracic motion. Many reports have addressed changes of scapular position across a spectrum of shoulder disease. However, no study has examined changes in scapular position after reverse total shoulder arthroplasty (RTSA). The purpose of this study was to evaluate the changes in scapular position after RTSA compared to patients’ contralateral, nonoperated shoulder. Methods Seven patients that underwent RTSA for cuff tear arthropathy from July 2007 to October 2008 were enrolled. The distance between the long axis of the thoracic spine and the inferior pole of the scapula (lateralization of the scapula) was measured on shoulder A-P radiographs at 0 degrees (the neutral position) and at 30, 60, 90, and 120 degrees of shoulder abduction. In addition, the angle between the long axis of the thoracic spine and medial border of the scapula was measured and compared with the patients’ contralateral shoulder. Results Scapulohumeral rhythm was 2.4:1 on the operated shoulder and 4.1:1 on the nonoperated, contralateral shoulder at 120 degrees of abduction. The distance between the line of the interspinous process of upper thoracic vertebra and the inferior pole of the scapula showed a negative slope at 0 to 30 degrees abduction on the operated side, but beyond 30 degrees of abduction, this distance showed a more sudden increase than in the contralateral shoulder. The angle between the vertical vertebral line and the scapular medial border also showed greater increase beyond 30 degrees abduction on the operated limb. Conclusions The pattern of scapular position after RTSA, was found to differ from that of the contralateral shoulder, and showed a more scapular upward rotation. PMID:23107368

  13. RESULTS FROM BI-CONTACT® TOTAL ELBOW ARTHROPLASTY: MULTICENTER STUDY

    PubMed Central

    Benegas, Eduardo; Malavolta, Eduardo Angeli; Gracitelli, Mauro Emilio Conforto; de Sousa, Augusto Tadeu Barros; Miyazaki, Alberto Naoki; Fregoneze, Marcelo; Ikemoto, Roberto Yukio; Murachovsky, Joel; Matsumoto, Marcelo Hide; Tamaoki, Marcel Jun Sugawara; Neto, Arnaldo Amado Ferreira

    2015-01-01

    Objective: To describe the initial experience of four orthopedic clinics from using Bi-Contact® total elbow arthroplasty (TEA), reporting the results and complications of the procedure. Methods: This was a retrospective study, through analysis on the medical records of patients who underwent primary TEA using a prosthesis model developed in conjunction with IOT-HCFMUSP. Forty-six elbows (45 patients) that were operated at four orthopedic clinics between 2000 and 2009 were evaluated. Results: The majority of the patients were female (74%), and the median age was 62.5 years. The diagnoses encountered were trauma sequelae (47.83%), rheumatoid arthritis (32.61%), primary osteoarthrosis (8.7%), acute fractures (6.52%) and heterotopic ossification (2.17%). The median length of follow-up was 2.08 years (0.25-9). The procedure significantly alleviated pain and improved range of motion. It was observed that at least one complication was present in 69.57% of the cases, and the main ones were infection (28.26%), need for revision (28.26%), intraoperative fracture (15.22%) and aseptic loosening (15.22%). Conclusion: Bi-Contact® TEA provided significant alleviation of pain and improvement of range of motion in the present series. The complication rate was high, and the most frequently observed complications were infection, aseptic loosening and intraoperative fracture. PMID:27027055

  14. [Twelve cases of total arthroplasty of lumbar disc. Preliminary results at 6 months].

    PubMed

    Morales, José Fernando Ramos; Palacios, Jesús López; Soriano, Juan Carlos Alvarado

    2008-01-01

    Lumbar pathology is a problem with growing incidence in developed countries. Lumbar pain caused by disc degeneration is the most frequently cause of functional restriction in patients under 45 years old. Discectomy, laminectomy and posterior spinal fusion have been the traditional surgery treatment. Many patients continue with pain as a consequence of mechanical damage at the functional unit, with different degrees of instability and adjacent disc damage. There are two types of strategies for disc replacement: disc nucleus arthroplasty and total disc arthroplasty. A clinical essay was made in Angeles Mocel Hospital during the period between October 2003 to March 2005. Eight patients with degenerative lumbar disc disease or contained disc herniation, were treated with 12 disc prosthesis, previously they showed no improvement with conservative treatment at minimum 4 months. Preoperative and postoperative pain was reported with the analogue visual score and the Oswestry score. Eighty percent presented immediate postoperative improvement and 100% after 6 months using Oswestry score. This procedure offers good outcome at short term, when its well indicated. This treatment requires a multidisciplinary team and elevates the costs. We need long term follow up results.

  15. SHOULDER ARTHROPLASTY RECORDS

    PubMed Central

    Filho, Geraldo Motta; Galvão, Marcus Vinicius; Monteiro, Martim; Cohen, Marcio; Brandão, Bruno

    2015-01-01

    The study's objective is to evaluate the characteristics and problems of patients who underwent shoulder arthroplasties between July 2004 and November 2006. Methodology: During the period of the study, 145 shoulder arthroplasties were performed. A prospective protocol was used for every patient; demographic, clinical and surgical procedure data were collected. All gathered data were included in the data base. The patients were divided in three major groups: fractures, degenerative diseases and trauma sequels. Information obtained from the data base was correlated in order to determine patients' epidemiologic, injuries, and surgical procedure profiles. Results: Of the 145 shoulder arthroplasties performed, 37% presented trauma sequels, 30% degenerative diseases, and 33% proximal humerus fracture. 12% of the cases required total arthroplasties and 88% partial arthroplasties. Five major complications were observed on early postoperative period. Conclusion: Shoulder arthroplasties have become a common procedure in orthopaedic practice. Surgical records are important in evidencing progressive evolution and in enabling future clinical outcomes evaluation. PMID:26998463

  16. Efficacy and safety of rivaroxaban thromboprophylaxis after arthroplasty of the hip or knee: retrospective cohort study.

    PubMed

    Loganathan, L; Hua, A; Patel, S; Gibbons, C; Vizcaychipi, M P

    2016-09-01

    Introduction Venous thromboembolism (VTE) is a potentially fatal complication of hip arthroplasty and knee arthroplasty. The National Institute for Health and Care Excellence recommend rivaroxaban for VTE prevention. Amid concerns over bleeding complications, the modified thromboprophylaxis policy of Chelsea and Westminster Hospital (CWH; London, UK) advises enoxaparin given after surgery in the inpatient setting followed by rivaroxaban upon hospital discharge. This retrospective study investigated the efficacy and safety of rivaroxaban in this novel, modified venous-prophylaxis regimen in a surgical orthopaedic cohort at CWH. Methods A total of 479 patients who received modified thromboprophylaxis treatment at CWH after hip arthroplasty or knee arthroplasty between April 2013 and October 2014 formed the study cohort. Seven outcomes based on efficacy and safety while undergoing treatment with rivaroxaban were investigated: symptomatic deep-vein thrombosis (DVT), pulmonary embolism (PE), death, stroke, myocardial infarction (MI), major bleeding episodes (MBEs) and non-major bleeding episodes (NMBEs). Median follow-up was 369 days. Fisher's exact and Mann-Whitney U-tests were adopted to identify associations with these outcomes. Results Prevalence of symptomatic PE, DVT, death, stroke and MI during treatment was zero. One (0.2%) MBE and nine (1.9%) NMBEs occurred. The MBE (a wound haematoma) required a return to theatre for aspiration. Off-treatment VTEs occurred in four (0.8%) patients after completion of a course of rivaroxaban, and were associated with known risk factors. Conclusions Rivaroxaban is an effective and safe anticoagulant for thromboprophylaxis after hip arthroplasty or knee arthroplasty if used in a modified regimen involving enoxaparin administered in the inpatient setting followed by rivaroxaban upon hospital discharge. PMID:27580310

  17. Efficacy and safety of rivaroxaban thromboprophylaxis after arthroplasty of the hip or knee: retrospective cohort study.

    PubMed

    Loganathan, L; Hua, A; Patel, S; Gibbons, C; Vizcaychipi, M P

    2016-09-01

    Introduction Venous thromboembolism (VTE) is a potentially fatal complication of hip arthroplasty and knee arthroplasty. The National Institute for Health and Care Excellence recommend rivaroxaban for VTE prevention. Amid concerns over bleeding complications, the modified thromboprophylaxis policy of Chelsea and Westminster Hospital (CWH; London, UK) advises enoxaparin given after surgery in the inpatient setting followed by rivaroxaban upon hospital discharge. This retrospective study investigated the efficacy and safety of rivaroxaban in this novel, modified venous-prophylaxis regimen in a surgical orthopaedic cohort at CWH. Methods A total of 479 patients who received modified thromboprophylaxis treatment at CWH after hip arthroplasty or knee arthroplasty between April 2013 and October 2014 formed the study cohort. Seven outcomes based on efficacy and safety while undergoing treatment with rivaroxaban were investigated: symptomatic deep-vein thrombosis (DVT), pulmonary embolism (PE), death, stroke, myocardial infarction (MI), major bleeding episodes (MBEs) and non-major bleeding episodes (NMBEs). Median follow-up was 369 days. Fisher's exact and Mann-Whitney U-tests were adopted to identify associations with these outcomes. Results Prevalence of symptomatic PE, DVT, death, stroke and MI during treatment was zero. One (0.2%) MBE and nine (1.9%) NMBEs occurred. The MBE (a wound haematoma) required a return to theatre for aspiration. Off-treatment VTEs occurred in four (0.8%) patients after completion of a course of rivaroxaban, and were associated with known risk factors. Conclusions Rivaroxaban is an effective and safe anticoagulant for thromboprophylaxis after hip arthroplasty or knee arthroplasty if used in a modified regimen involving enoxaparin administered in the inpatient setting followed by rivaroxaban upon hospital discharge.

  18. Increased Long-Term Cardiovascular Risk After Total Hip Arthroplasty: A Nationwide Cohort Study.

    PubMed

    Gordon, Max; Rysinska, Agata; Garland, Anne; Rolfson, Ola; Aspberg, Sara; Eisler, Thomas; Garellick, Göran; Stark, André; Hailer, Nils P; Sköldenberg, Olof

    2016-02-01

    Total hip arthroplasty is a common and important treatment for osteoarthritis patients. Long-term cardiovascular effects elicited by osteoarthritis or the implant itself remain unknown. The purpose of the present study was to determine if there is an increased risk of late cardiovascular mortality and morbidity after total hip arthroplasty surgery.A nationwide matched cohort study with data on 91,527 osteoarthritis patients operated on, obtained from the Swedish Hip Arthroplasty Register. A control cohort (n = 270,688) from the general Swedish population was matched 1:3 to each case by sex, age, and residence. Mean follow-up time was 10 years (range, 7-21).The exposure was presence of a hip replacement for more than 5 years. The primary outcome was cardiovascular mortality after 5 years. Secondary outcomes were total mortality and re-admissions due to cardiovascular events.During the first 5 to 9 years, the arthroplasty cohort had a lower cardiovascular mortality risk compared with the control cohort. However, the risk in the arthroplasty cohort increased over time and was higher than in controls after 8.8 years (95% confidence interval [CI] 7.0-10.5). Between 9 and 13 years postoperatively, the hazard ratio was 1.11 (95% CI 1.05-1.17). Arthroplasty patients were also more frequently admitted to hospital for cardiovascular reasons compared with controls, with a rate ratio of 1.08 (95% CI 1.06-1.11).Patients with surgically treated osteoarthritis of the hip have an increased risk of cardiovascular morbidity and mortality many years after the operation when compared with controls. PMID:26871792

  19. Which Are the Most Frequently Used Outcome Instruments in Studies on Total Ankle Arthroplasty?

    PubMed Central

    Impellizzeri, Franco M.; Rippstein, Pascal F.

    2009-01-01

    The number of studies reporting on outcomes after total ankle arthroplasty is continuously increasing. As the use of valid outcome measures represents the cornerstone for successful clinical research, we aimed to identify the most frequently used outcome instruments in ankle arthroplasty studies and to analyze the evidence to support their use in terms of different quality criteria. A systematic review of the literature identified 15 outcome instruments reported in 79 original studies. The most commonly used measures were the American Orthopaedic Foot and Ankle Society hindfoot score (n = 41), the Kofoed ankle score (n = 21), a visual analog scale assessing pain (n = 15), and the generic SF-36 (n = 6). Eight additional instruments were used only once or twice. The American Orthopaedic Foot and Ankle Society and Kofoed instruments include a clinical examination and score up to 100 points. Evidence to support their use in terms of validity, reliability, responsiveness, and interpretability is limited, raising the question whether their use is justified. Self-reported questionnaires related to ankle osteoarthritis or arthroplasty are rather disregarded in the current literature, and only the Foot Function Index is associated with evidence in terms of the above-mentioned quality criteria. Future research is warranted to improve the outcome assessment after total ankle arthroplasty. PMID:19672670

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

    PubMed

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

    2009-10-01

    This study prospectively investigates whether catastrophizing thinking is associated with length of hospital stay after total knee arthroplasty. Forty-three patients who underwent primary total knee arthroplasty were included in this study. Prior to their operation all patients were asked to complete the pain catastrophizing scale, and a Western Ontario McMaster Universities Osteoarthritis index. A multiple regression analysis identified pain catastrophizing thinking and age as predictors of hospital stay after total knee arthroplasty. Patients with a higher degree of pain catastrophizing prior to the total knee arthroplasty and those with a higher age have a significantly greater risk for a longer hospital stay. Therefore, the results of this study indicate that the pre-operative level of pain catastrophizing in patients determine, in combination with other variables, the length and inter-individual variation in hospital stay after total knee arthroplasty. Reducing catastrophizing thinking about pain through cognitive-behavioral techniques is likely to reduce levels of fear after total knee arthroplasty. As a result, pain and function immediately post-operative might improve, leading to a decrease in length of hospital stay. Although during the last decades the duration of hospital stay is significantly reduced, this study shows that this can be improved when taking into account the contribution of psychological factors such as pain catastrophizing.

  1. Study of Glove Perforation during Hip Replacement Arthroplasty: Its Frequency, Location, and Timing

    PubMed Central

    Tao, Li Xiao

    2014-01-01

    Objective. The aim of the study was to evaluate the location, timing, and frequency of glove perforation during hip replacement arthroplasty. Methods. Gloves worn by surgical team members in 19 primary hip replacement arthroplasties were assessed. The study was of a single gloving system. All the used gloves were collected at the end of the surgery and assessed visually and by using water inflation technique. Relevant data were collected at the time of surgery. Results. A total of one hundred and ninety-one surgical gloves were evaluated. Twenty-three glove perforations were noted in nineteen of the operations. Of these perforations 14 belonged to gloves worn by surgeon and first assistant (60.1%). Glove perforation in thumb, index finger, and palm was more common. More perforation occurred in the gloves worn in nondominant hand (52%) but was insignificant. Conclusion. Glove perforation in surgeries such as total hip arthroplasty is not uncommon. In this study of single gloving system glove perforation rate was 12.04%, whereas literature reports of glove perforation rate as low as 3.3% in elective orthopedic surgeries with double gloving system. As such emphasis should be given to wear double pair of gloves wherever this practice is uncommon. PMID:27350965

  2. Preliminary decommissioning study reports

    SciTech Connect

    Peretz, F.J.

    1984-09-01

    The Molten Salt Reactor Experiment (MSRE) is one of approximately 76 facilities currently managed by the ORNL Surplus Facilities Management Program (SFMP). This program, as part of the DOE national SFMP, is responsible for the maintenance and surveillance and the final decommissioning of radioactively-contaminated surplus ORNL facilities. A long range planning effort is being conducted that will outline the scope and objectives of the ORNL program and establish decommissioning priorities based on health and safety concerns, budget constraints, and other programmatic constraints. In support of this SFMP planning activity, preliminary engineering assessments are being conducted for each of the ORNL surplus facilities currently managed under the program. These efforts, in general, are designed to: (1) provide an initial assessment of the potential decommissioning alternatives; (2) choose a preferred alternative and provide a justification for that choice, and (3) provide a preliminary description of the decommissioning plan, including cost and schedule estimates. Because of several issues which cannot be evaluated quantitatively at this time, this report on the MSRE does not select a most probable decommissioning mode'' but rather discusses the issues and representative alternatives for disposal of the MSRE fuel salts and decommissioning of the facility. A budget and schedule representative of the types of activities likely to be required is also suggested for preliminary use in the SFMP Long Range Plan.

  3. Gait and stair function in total and resurfacing hip arthroplasty: a pilot study.

    PubMed

    Shrader, M Wade; Bhowmik-Stoker, Manoshi; Jacofsky, Marc C; Jacofsky, David J

    2009-06-01

    Standard total hip arthroplasty (THA) is the established surgical treatment for patients older than 65 years with progressive osteoarthritis but survivorship curves wane in patients younger than 50. Resurfacing hip arthroplasty (RHA) is an alternative for younger, active patients reportedly providing superior range of motion. Quantitative investigation of functional recovery following arthroplasty may elucidate limitations that aid in device selection. Although limited long-term kinematic data are available, the early rate of recovery and gait compensations are not well described. This information may aid in refining rehabilitation protocols based on limitations specific to the implant. We presumed hip motion and forces for subjects receiving RHA are more similar to age-matched controls during physically demanding tasks, such as stair negotiation, at early time points than those for THA. In a pilot study, we quantified walking and stair negotiation preoperatively and 3 months postoperatively for seven patients with RHA (mean age, 49 years), seven patients with standard THA (mean age, 52 years), and seven age-matched control subjects (mean age, 56 years). Although both treatment groups demonstrated trends toward functional recovery, the RHA group had greater improvements in hip extension and abduction moment indicating typical loading of the hip. Further investigation is needed to determine if differences persist long term or are clinically meaningful. PMID:19305961

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

    PubMed

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

    2015-11-01

    [Purpose] The aim of this study was to evaluate the efficacy of mechanical massage via Endermologie(®) after total knee arthroplasty in reducing edema and pain and improving knee range of motion, in the early postoperative period. [Subjects and Methods] Eighteen patients with knee edema following total knee arthroplasty were randomly assigned to the intervention group (n=8) or the control group (n=10). The intervention group received mechanical massage therapy using Endermologie(®) and the control group received conventional physical therapy for 20 minutes a day, 5 times a week from the seventh day postsurgery. Clinical assessments included active knee flexion and extension range of motion, knee pain using a numeric rating scale, the operated limb circumference, the soft tissue cross-sectional area using ultrasonography, the extracelluar fluid volume, and single frequency bioimpedance analysis at 5 kHz using bioelectrical impedance spectroscopy. [Results] Both groups showed significant reduction in edema and pain, and improvement in active knee flexion at the end of treatment. There were no significant inter-group differences before or after treatment. [Conclusion] Mechanical massage could be an alternative way of managing knee edema after total knee arthroplasty in early postoperative recovery.

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

    PubMed Central

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

    2015-01-01

    [Purpose] The aim of this study was to evaluate the efficacy of mechanical massage via Endermologie® after total knee arthroplasty in reducing edema and pain and improving knee range of motion, in the early postoperative period. [Subjects and Methods] Eighteen patients with knee edema following total knee arthroplasty were randomly assigned to the intervention group (n=8) or the control group (n=10). The intervention group received mechanical massage therapy using Endermologie® and the control group received conventional physical therapy for 20 minutes a day, 5 times a week from the seventh day postsurgery. Clinical assessments included active knee flexion and extension range of motion, knee pain using a numeric rating scale, the operated limb circumference, the soft tissue cross-sectional area using ultrasonography, the extracelluar fluid volume, and single frequency bioimpedance analysis at 5 kHz using bioelectrical impedance spectroscopy. [Results] Both groups showed significant reduction in edema and pain, and improvement in active knee flexion at the end of treatment. There were no significant inter-group differences before or after treatment. [Conclusion] Mechanical massage could be an alternative way of managing knee edema after total knee arthroplasty in early postoperative recovery. PMID:26696709

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

    PubMed Central

    Al-Omran, Abdallah S.

    2014-01-01

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

  7. Trajectories of Pain and Function after Primary Hip and Knee Arthroplasty: The ADAPT Cohort Study

    PubMed Central

    Lenguerrand, Erik; Wylde, Vikki; Gooberman-Hill, Rachael; Sayers, Adrian; Brunton, Luke; Beswick, Andrew D.; Dieppe, Paul; Blom, Ashley W.

    2016-01-01

    Background and Purpose Pain and function improve dramatically in the first three months after hip and knee arthroplasty but the trajectory after three months is less well described. It is also unclear how pre-operative pain and function influence short- and long-term recovery. We explored the trajectory of change in function and pain until and beyond 3-months post-operatively and the influence of pre-operative self-reported symptoms. Methods The study was a prospective cohort study of 164 patients undergoing primary hip (n = 80) or knee (n = 84) arthroplasty in the United Kingdom. Self-reported measures of pain and function using the Western Ontario and McMaster Universities Osteoarthritis index were collected pre-operatively and at 3 and 12 months post-operatively. Hip and knee arthroplasties were analysed separately, and patients were split into two groups: those with high or low symptoms pre-operatively. Multilevel regression models were used for each outcome (pain and function), and the trajectories of change were charted (0–3 months and 3–12 months). Results Hip: Most improvement occurred within the first 3 months following hip surgery and patients with worse pre-operative scores had greater changes. The mean changes observed between 3 and twelve months were statistically insignificant. One year after surgery, patients with worse pre-operative scores had post-operative outcomes similar to those observed among patients with less severe pre-operative symptoms. Knee: Most improvement occurred in the first 3 months following knee surgery with no significant change thereafter. Despite greater mean change during the first three months, patients with worse pre-operative scores had not ‘caught-up’ with those with less severe pre-operative symptoms 12 months after their surgery. Conclusion Most symptomatic improvement occurred within the first 3 months after surgery with no significant change between 3–12 months. Further investigations are now required to

  8. First metacarpal resurfacing with polyvinyl alcohol implant in osteoarthritis: preliminary study.

    PubMed

    Taleb, C; Berner, S; Mantovani Ruggiero, G

    2014-06-01

    Osteoarthritis of first carpometacarpal (CMC) joint is a condition that is frequently encountered in hand surgery. If conservative treatment fails, several surgical procedures are available ranging from arthroscopic debridement to total joint arthroplasty. This study focuses on a new resurfacing technique for the base of the first metacarpal using a polyvinyl alcohol hydrogel implant. Our preliminary study found good clinical outcomes and no inflammatory reaction after a follow-up of 30 months. However prospective studies with a longer follow-up and more patient are needed to confirm these results.

  9. Minimally Invasive Total Knee Arthroplasty: A Comparative Study to the Standard Approach

    PubMed Central

    Dabboussi, Naji; Sakr, Mazen; Girard, Julien; Fakih, Riad

    2012-01-01

    Background: Minimally invasive surgery has gained popularity over the past several years. Early results have shown better functional outcome with early recovery and rapid rehabilitation. Aim: Evaluation of the short-term clinical and functional outcome of minimally invasive surgery total knee arthroplasty (MIS-TKA) compared with the traditional total knee arthroplasty (TKA). Materials and Methods: During 2009, all cases scheduled for primary TKA through the modified mini-mid-vastus approach (MIS group) were studied. This group included 40 knees and was compared to a cohort control group of similar number of patients (40 knees) that underwent the procedure through the standard conventional technique (standard group). Results: Patients in the MIS group showed significant decrease in postoperative pain, blood loss in first 24 hours, and in hospital stay. Furthermore, they achieved motion considerably faster than the standard group with earlier return of quadriceps function and greater early flexion. Conclusion: This study proved that MIS-TPA has the ability to couple the benefits of less invasive surgical approach. PMID:22408753

  10. Safety of desirudin in thrombosis prevention after total knee arthroplasty: the DESIR-ABLE study.

    PubMed

    Jove, Maurice; Maslanka, Marc; Minkowitz, Harold S; Jaffer, Amir K

    2014-01-01

    Desirudin, administered 30 minutes before total hip arthroplasty is superior to enoxaparin in preventing proximal deep vein thrombosis (DVT) and pulmonary embolism (PE) with similar bleeding. The purpose of this study was to determine the safety of desirudin in patients undergoing elective total knee arthroplasty (TKA) when the first dose of desirudin was administered the evening after surgery. This is a case series of patients undergoing TKA who received desirudin 15 mg every 12 hours subcutaneously for an average of 5 days with the first dose administered postoperatively. The primary endpoint was major bleeding; secondary endpoints included wound outcomes (oozing and infection) and new symptomatic DVT or PE. Desirudin has a favorable safety profile when administered postoperatively in patients undergoing TKA with no reports of major bleeding, wound ooze, or infection. No patients experienced symptomatic DVT, but 2 patients had PE detected by computed tomography after experiencing atypical symptoms. The safety profile of desirudin is improved when administered postoperatively. Bleeding and wound outcomes seem to occur less frequently than historical desirudin and enoxaparin controls.

  11. Clinical characteristics and risk factors of periprosthetic femoral fractures associated with hip arthroplasty: A retrospective study.

    PubMed

    Zhang, Zhendong; Zhuo, Qi; Chai, Wei; Ni, Ming; Li, Heng; Chen, Jiying

    2016-08-01

    Periprosthetic femoral fracture (PFF) is a complicated complication of both primary and revision hip arthroplasty with an increasing incidence. The present study aimed to summarize the clinical characteristics and identify the risk factors for PFF which would be potentially helpful in the prevention and treatment of PFF.We retrospectively analyzed the clinical data of 89 cases of PFF, and a case-control study was designed to identify the potential risk for intraoperative and postoperative PFF in both primary and revision hip arthroplasty.The overall incidence of PFF was 2.08% (intraoperative: 1.77%, postoperative: 0.30%, revision: 13.60%, and primary: 0.97%). The most commonly used treatment strategy was fixation with cerclage wire or band for intraoperative PFF, whereas long stem revision with plate or cortical allograft strut fixation was the main treatment strategy for postoperative PFF. The risk factors for intraoperative PFF in primary total hip arthroplasty (THA) included the diagnosis of development dysplasia of the hip (DDH) (odds ratio [OR] = 5.01, 95%CI, 1.218-20.563, P=0.03) and CBR ≥ 0.49 (OR = 3.34, 95%CI, 1.138-9.784, P = 0.03). The increased age was associated with increased incidence of postoperative PFF in primary THA (OR = 1.09, 95%CI, 1.001-1.194, P = 0.04). As for the intraoperative PFF in revision THA, we found that receiving multiple operations before revision (OR = 2.45, 95%CI, 1.06-5.66, P = 0.04), revisions due to prosthetic joint infection (OR = 6.72, 95%CI, 1.007-44.832, P = 0.04), the presence of cementless implant before revision (OR = 13.54, 95%CI, 3.103-59.08, P = 0.001), and femoral deformity (OR = 8.03, 95%CI, 1.656-38.966, P = 0.01) were all risk factors.Screening for high-risk patients, preoperative templating, and detailed discharge instructions may be the potential strategies to reduce the incidence of PFF. The treatment of PFFs should take into account Vancouver

  12. Obese patients undergoing total knee arthroplasty have distinct preoperative characteristics: an institutional study of 4718 patients.

    PubMed

    Vulcano, Ettore; Lee, Yuo-Yu; Yamany, Tarek; Lyman, Stephen; Valle, Alejandro González Della

    2013-08-01

    Obesity affects a disproportionate proportion of total knee arthroplasty (TKA) patients. Our study explores pre-operative characteristics between obese and non-obese patients undergoing TKA surgery. A cohort of 4718 osteoarthritic patients, undergoing primary TKA, was studied. Patients were stratified according to BMI classes. Each class was compared in terms of age, race, gender, level of education, insurance status, pre-operative WOMAC, SF-36, and Elixhauser comorbidities. There was a positive relationship between BMI and female gender, non-white race, Medicaid, private insurance, and self-pay. A negative relationship was observed between BMI and age, Medicare, WOMAC and SF-36. Obese TKA candidates differ from their non-obese counterparts in a number of demographic, socioeconomic, and clinical characteristics. PMID:23523207

  13. The clinical efficacy of using autologous platelet rich plasma in hip arthroplasty: A retrospective comparative study

    PubMed Central

    Safdar, Atif; Shaaban, Hamid; Tibayan, Restituto; Miller, Richard; Boairdo, Richard; Guron, Gunwant

    2015-01-01

    Background: Platelet rich plasma (PRP) is a blood derivative concentrate of platelets, fibrin and growth factors obtained through withdrawal and centrifugation of autologous blood and use for its inherent hemostatic and adhesive properties to promote wound healing. Hip arthroplasty is often associated with significant perioperative complications including blood loss necessitating blood transfusions, which can lead to multiple adverse reactions, infection transmission, and longer hospital stay. Materials and Methods: We conducted this retrospective comparative study to determine whether the use of PRP can reduce the bleeding complications in hip replacement surgeries and therefore decrease analgesic requirements and shorten the hospital stay. Results: Sixty patients had consecutive hip replacement surgeries. The study group (n=23) received PRP applications while the control group (n=37) were operated without PRP applications. Postoperative drop of hemoglobin, number of red blood cell (RBC) transfusions, analgesic requirements, and duration of hospital stay were recorded. There was no significant difference in the drop of hemoglobin preoperatively and postoperatively comparing study and control groups (P=0.75). There was no difference in transfusion requirements between the two groups (P=0.16) but there was trend toward less transfusion in the PRP-treated group. There were also no statistical differences in analgesic use (P=0.83) and lengths of hospitalization (P=0.68) between the two groups. Conclusion: We concluded that there is no clinical efficacy in using PRP in hip replacement surgeries. We recommend a larger prospective study be conducted to determine its clinical utility as an optimization strategy to improve outcome after hip arthroplasty PMID:25810634

  14. Retrospective study of scapular notches in reverse shoulder arthroplasties.

    PubMed

    Torrens, Carlos; Santana, Fernando; Picazo, Benito; Cáceres, Enric

    2013-08-01

    We conducted a retrospective study of 36 patients with reverse shoulder prostheses to assess whether placement of the glenoid component affected development of scapular notches. Minimum follow-up was 2 years. Glenosphere position and its relation to scapular notching was analyzed radiographically. The glenosphere overhung the inferior glenoid rim in 19 cases (52.8%) and was flush with the rim in the other 17 cases (47.2%). A scapular notch developed in 13 (36.1%) of the 36 cases. The notch developed in 8 (42.1%) of the 19 cases in which the glenosphere overhung the inferior rim, and in 5 (29.4%) of the 17 cases in which the glenosphere was flush with the rim. There were no significant differences (P = .601) between the 2 groups (overhanging vs flush glenoid component) with respect to development of scapular notching. Preoperative and postoperative Constant-Murley Shoulder Outcome scores were 19.42 and 49.21 for the group with scapular notches, and 25.09 and 51.96 for the group without notches. From a clinical viewpoint, there were no significant differences in scapular notch development and functional Constant-Murley Shoulder Outcome scores between glenospheres overhanging the glenoid rim and glenospheres flush with the glenoid rim. PMID:24078954

  15. Time trends in total ankle arthroplasty in the USA: a study of the National Inpatient Sample.

    PubMed

    Singh, Jasvinder A; Ramachandran, Rekha

    2016-01-01

    The objective of this study was to assess the time trends in utilization, clinical characteristics, and outcomes of patients undergoing total ankle arthroplasty (TAA) in the USA. We used the Nationwide Inpatient Sample (NIS) data from 1998 to 2010 to examine time trends in the utilization rates of TAA. We used the Cochran Armitage test for trend to assess time trends across the years and the analysis of variance (ANOVA), Wilcoxon test, or chi-squared test (as appropriate) to compare the first (1998-2000) and the last time periods (2009-2010). TAA utilization rate increased significant from 1998 to 2010: 0.13 to 0.84 per 100,000 overall, 0.14 to 0.88 per 100,000 in females, and from 0.11 to 0.81 per 100,000 in males (p < 0.0001 for each comparison for time trends). Compared to the 1998-2000 period, those undergoing TAA in 2009-2010 were older (41% fewer patients <50 years, p < 0.0001), less likely to have rheumatoid arthritis as the underlying diagnosis (55% fewer patients, p = 0.0001), more likely to have Deyo-Charlson index of 2 or more (197% more, p = 0.0010), and had a shorter length of stay at 2.5 days (17% reduction, p < 0.0001). Mortality was rare ranging from 0 to 0.6% and discharge to inpatient facility ranged 12.6-14.1%; we noted no significant time trends in either (p > 0.05). The utilization rate of TAA increased rapidly in the USA from 1998 to 2010, but post-arthroplasty mortality rate was stable. Underlying diagnosis and medical comorbidity changed over time and both can impact outcomes after TAA. Further studies should examine how the outcomes and complications of TAA have evolved over time.

  16. Dielectric cure monitoring: Preliminary studies

    NASA Technical Reports Server (NTRS)

    Goldberg, B. E.; Semmel, M. L.

    1984-01-01

    Preliminary studies have been conducted on two types of dielectric cure monitoring systems employing both epoxy resins and phenolic composites. An Audrey System was used for 23 cure monitoring runs with very limited success. Nine complete cure monitoring runs have been investigated using a Micromet System. Two additional measurements were performed to investigate the Micromet's sensitivity to water absorption in a post-cure carbon-phenolic material. While further work is needed to determine data significance, the Micromet system appears to show promise as a feedback control device during processing.

  17. Total ankle replacement: a population-based study of 515 cases from the Finnish Arthroplasty Register

    PubMed Central

    Koivu, Helka; Eskelinen, Antti; Ikävalko, Mikko; Paavolainen, Pekka; Remes, Ville

    2010-01-01

    Background and purpose Although total ankle replacement (TAR) is a recognized procedure for treatment of the painful arthritic ankle, the best choice of implant and the long-term results are still unknown. We evaluated the survival of two TAR designs and factors associated with survival using data from the nationwide arthroplasty registry in Finland. Methods 573 primary TARs were performed during the period 1982–2006 because of rheumatic, arthritic, or posttraumatic ankle degeneration. We selected contemporary TAR designs that were each used in more than 40 operations, including the S.T.A.R. (n = 217) and AES (n = 298), to assess their respective survival rates. The mean age of the patients was 55 (17–86) years and 63% of operations were performed in women. Kaplan-Meier analysis and the Cox regression model were used for survival analysis. The effects of age, sex, diagnosis, and hospital volume were also studied. Results The annual incidence of TAR was 1.5 per 105 inhabitants. The 5-year overall survivorship for the whole TAR cohort was 83% (95% CI: 81–86), which agrees with earlier reports. The most frequent reasons for revision were aseptic loosening of one or both of the prosthesis components (39%) and instability (39%). We found no difference in survival rate between the S.T.A.R. and AES designs. Furthermore, age, sex, diagnosis, and hospital volume (< 10 and > 100 replacements in each of 17 hospitals) did not affect the TAR survival. Interpretation Based on our findings, we cannot conclude that any prosthesis was superior to any other. A high number of technical errors in primary TARs suggests that this low-volume field of implant arthroplasty should be centralized to fewer units. PMID:20180720

  18. Patellofemoral arthroplasty: a multi-centre study with minimum 2-year follow-up

    PubMed Central

    Leadbetter, Wayne B.; Kolisek, Frank R.; Levitt, Richard L.; Brooker, Andrew F.; Zietz, Patrick; Marker, David R.; Bonutti, Peter M.

    2008-01-01

    Recently, patellofemoral arthroplasty has attracted increased interest as a salvage treatment for isolated patellofemoral arthritis. However, there are very few reports of the experience with modern generation patellofemoral arthroplasties. This investigation describes a collective experience of four centres reporting on the outcome in patients of the use of one patellofemoral arthroplasty device. There were 70 patients (79 knees) who had failed an extensive non-operative treatment regimen and/or various conventional alternative surgical treatments. At a mean follow-up of three years (range: 2–6 years), there were 66 knees that had Knee Society Scores greater than 80 points (84%). Seventy-one knees (90%) functioned without pain in daily activity and stair climbing. Symptomatic isolated patellofemoral arthritis was successfully treated with a patellofemoral arthroplasty in the short term. We are encouraged by these excellent early results and await longer follow-up. PMID:19057900

  19. Malnutrition in Joint Arthroplasty: Prospective Study Indicates Risk of Unplanned ICU Admission

    PubMed Central

    Kamath, Atul F.; McAuliffe, Caitlin L.; Kosseim, Laura M.; Pio, Finnah; Hume, Eric

    2016-01-01

    Background: Malnutrition has been linked to poor outcomes after elective joint arthroplasty, but the risk of unplanned postoperative intensive care unit (ICU) admission in malnourished arthroplasty patients is unknown. Methods: 1098 patients were followed as part of a prospective risk stratification program at a tertiary, high-volume arthroplasty center. Chronic malnutrition was defined as preoperative albumin <3.5 g/dL. Results: The overall incidence of malnutrition was 16.9% (primary and revision arthroplasty patients). Average BMI was highest for patients in albumin category 3.0-3.5 (BMI 35.7). Preoperative albumin <3.0 and <3.5 g/dL translated to 15.4% and 3.8% rates of unplanned ICU admission, respectively, indicating nutritional status to be a factor in postoperative ICU admission. Conclusion: Patients with poor nutritional status must be counseled on the risks of adverse medical complications. PMID:27200389

  20. Evaluation of the effects of a physiotherapy program on quality of life in females after unilateral total knee arthroplasty: a prospective study.

    PubMed

    Hudáková, Zuzana; Zięba, Halina Romualda; Lizis, Paweł; Dvořáková, Vlasta; Cetlová, Lada; Friediger, Teresa; Kobza, Wojciech

    2016-05-01

    [Purpose] Osteoarthritis is a chronic and degenerative joint disease and is considered to be one of the most common musculoskeletal disorders. This study evaluated the differences in the quality of life of females treated with supervised physiotherapy and a standardized home program after unilateral total knee arthroplasty. [Subjects and Methods] From January 2012 to May 2015, a total of 40 females were examined at the Central Military Hospital in Ruzomberk, Slovakia. Quality of life was assessed with the Short Form-36. Quality of life and intensity of pain after normal daily activity, according to the visual analog scale, were assessed before total knee arthroplasty, immediately after physiotherapy, 3 months after total knee arthroplasty, and 6 months after total knee arthroplasty. [Results] We found statistically significant improvement of the quality of life results and a decreased intensity of pain at each time point compared with before total knee arthroplasty. [Conclusions] The results of this study provide further evidence indicating that patients who undergo total knee arthroplasty for primary osteoarthritis of the knee can achieve a significant improvement in the quality of life by using supervised physiotherapy compared with a standardized home program. PMID:27313341

  1. Evaluation of the effects of a physiotherapy program on quality of life in females after unilateral total knee arthroplasty: a prospective study.

    PubMed

    Hudáková, Zuzana; Zięba, Halina Romualda; Lizis, Paweł; Dvořáková, Vlasta; Cetlová, Lada; Friediger, Teresa; Kobza, Wojciech

    2016-05-01

    [Purpose] Osteoarthritis is a chronic and degenerative joint disease and is considered to be one of the most common musculoskeletal disorders. This study evaluated the differences in the quality of life of females treated with supervised physiotherapy and a standardized home program after unilateral total knee arthroplasty. [Subjects and Methods] From January 2012 to May 2015, a total of 40 females were examined at the Central Military Hospital in Ruzomberk, Slovakia. Quality of life was assessed with the Short Form-36. Quality of life and intensity of pain after normal daily activity, according to the visual analog scale, were assessed before total knee arthroplasty, immediately after physiotherapy, 3 months after total knee arthroplasty, and 6 months after total knee arthroplasty. [Results] We found statistically significant improvement of the quality of life results and a decreased intensity of pain at each time point compared with before total knee arthroplasty. [Conclusions] The results of this study provide further evidence indicating that patients who undergo total knee arthroplasty for primary osteoarthritis of the knee can achieve a significant improvement in the quality of life by using supervised physiotherapy compared with a standardized home program.

  2. Evaluation of the effects of a physiotherapy program on quality of life in females after unilateral total knee arthroplasty: a prospective study

    PubMed Central

    Hudáková, Zuzana; Zięba, Halina Romualda; Lizis, Paweł; Dvořáková, Vlasta; Cetlová, Lada; Friediger, Teresa; Kobza, Wojciech

    2016-01-01

    [Purpose] Osteoarthritis is a chronic and degenerative joint disease and is considered to be one of the most common musculoskeletal disorders. This study evaluated the differences in the quality of life of females treated with supervised physiotherapy and a standardized home program after unilateral total knee arthroplasty. [Subjects and Methods] From January 2012 to May 2015, a total of 40 females were examined at the Central Military Hospital in Ruzomberk, Slovakia. Quality of life was assessed with the Short Form-36. Quality of life and intensity of pain after normal daily activity, according to the visual analog scale, were assessed before total knee arthroplasty, immediately after physiotherapy, 3 months after total knee arthroplasty, and 6 months after total knee arthroplasty. [Results] We found statistically significant improvement of the quality of life results and a decreased intensity of pain at each time point compared with before total knee arthroplasty. [Conclusions] The results of this study provide further evidence indicating that patients who undergo total knee arthroplasty for primary osteoarthritis of the knee can achieve a significant improvement in the quality of life by using supervised physiotherapy compared with a standardized home program. PMID:27313341

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

    PubMed

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

    2013-09-01

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

  4. Alpine Skiing With total knee ArthroPlasty (ASWAP): study design and intervention.

    PubMed

    Kösters, A; Pötzelsberger, B; Dela, F; Dorn, U; Hofstaedter, T; Fink, C; Müller, E

    2015-08-01

    The aim of this study was to monitor the long-term effects of skiing on health-related parameters and implant related factors like loosening and wear in patients with total knee arthroplasty. This paper describes the overall study design, general demographics, and physiological demand of the intervention phase. A control group design consisting of an intervention group (n = 14; age: 70.4 ± 4.5 years) and a control group (n = 17; age: 71.5 ± 5.1 years) was utilized in this study. Parameters of interest were measured during pre-, post-, and retention test sessions. During the 12 weeks of intervention, an average of 25.5 days of guided skiing was conducted by each patient. Daily heart rate (HR) profiles and global positioning system data throughout the ski day were recorded. The intervention group completed an average of 3393 vertical meters of downhill skiing, with a total skiing distance of 33.6 km/day. Average skiing speed was 8.2 m/s. In the skiing phase, the average physiological load was 75.9 ± 6.6% of HRmax . Further effects of the 12-week skiing intervention on the tested parameters will be reported in the following papers of this supplementum. PMID:26083696

  5. Effect of shed blood retransfusion on pulmonary perfusion after total knee arthroplasty: a prospective controlled study

    PubMed Central

    Kaya, Eser; Kose, Kamil Cagri; Fidan, Fatma; Ergan, Volkan; Fidan, Hüseyin

    2006-01-01

    Postoperative shed blood retransfusion (autotransfusion) is a commonly used salvage method following major surgical operations, such as total knee arthroplasty (TKA). The systemic effects of shed blood are still unclear. We studied the effect of residual substances in the retransfused shed blood, on lung perfusion after TKA. Fifteen unilateral and one bilateral TKAs were performed with autotransfusion (the study group) and 15 unilateral and three bilateral TKAs were performed in a control group. Lung X-rays, arterial blood gases (ABG), D-dimer values, and lung perfusion scintigraphies were performed preoperatively and postoperatively. A mean of 300.0 ± 335.6 ml of bank blood was needed in the autotransfusion group and a mean of 685.7 ± 365.5 ml of bank blood was needed in the control group (p=0.001). There was a postoperative segmental perfusion defect at the lateral segment of the superior lobe of the left lung in one patient of the control group and he also had risk factors for thrombosis. Although both groups had a decrease in lung perfusion postoperatively, there were no significant differences among the groups regarding the lung perfusion scintigraphy, chest X-rays, ABG, and D-dimer values. In conclusion, although pulmonary perfusion diminishes following TKA, shed blood retransfusion does not add any risk to pulmonary perfusion. PMID:17115155

  6. Stance time variability during stair stepping before and after total knee arthroplasty: A pilot study.

    PubMed

    Smith, Jessica W; Marcus, Robin L; Tracy, Brian L; Foreman, K Bo; Christensen, Jesse C; LaStayo, Paul C

    2016-02-01

    The main objectives of this pilot study were to: (1) investigate stance time variability (STV) during stair stepping in older adults with osteoarthritis (OA) before and after total knee arthroplasty (TKA), and compare to an age- and sex-matched group of healthy controls with native knees and (2) evaluate the relationship between quadriceps strength and STV during stair stepping before and after TKA. A prospective, observational, pilot study was carried out on 13 individuals (15% male, mean age 62.71±6.84years) before and after TKA using an instrumented stairway, patient-reported outcomes, timed stair stepping test, and quadriceps strength measures. At 6-months post-operatively, STV during stair descent was significantly greater in the TKA-GROUP compared to the CONTROL-GROUP, but was not significantly different at 12-months compared to controls. There were no significant differences in STV for stair ascent between the pre- and post-operative visits, or compared to controls. There was a trend toward significance for the relationship between quadriceps strength and STV during stair ascent (P=0.059) and descent (P=0.073). Variability during stair stepping may provide an important, short-term rehabilitation target for individuals following TKA and may represent another parameter to predict declines in functional mobility.

  7. Anterior Longitudinal Osteotomy of the Greater Trochanter in Total Hip Arthroplasty.

    PubMed

    Surace, Michele F; Regazzola, Gianmarco M V; Vulcano, Ettore; Monestier, Luca; Cherubino, Paolo

    2015-08-01

    The extra-articular impingement of the greater trochanter against the ileum is an underrated cause of early dislocation in total hip arthroplasty. In this preliminary study, the authors assess the effectiveness of an anterior longitudinal osteotomy of the greater trochanter for preventing dislocation. A total of 115 patients underwent a total hip arthroplasty through a posterolateral approach. All patients underwent clinical and radiological follow-up at 1, 3, and 6 months. No dislocation was reported. All patients demonstrated fast recovery of range of motion and walking. No trochanter fractures were observed. The osteotomy of the greater trochanter is an effective surgical technique that decreases anterior impingement and consequently lowers the dislocation rate in primary total hip arthroplasty. [Orthopedics. 2015; 38(8):490-493.]. PMID:26313167

  8. Conversion to Reverse Shoulder Arthroplasty: Humeral Stem Retention Versus Revision.

    PubMed

    Dilisio, Matthew F; Miller, Lindsay R; Siegel, Elana J; Higgins, Laurence D

    2015-09-01

    As the volume of shoulder arthroplasty procedures performed in the United States continues to increase, the predicted number of revision shoulder arthroplasties grows even higher. Conversion of failed shoulder arthroplasty to reverse total shoulder arthroplasty has become common. Many commercially available shoulder arthroplasty systems now offer a platform humeral stem that is used for both anatomic shoulder arthroplasty and reverse total shoulder arthroplasty. This study investigated whether retaining the humeral stem offers advantages over revising the humeral stem in conversion of failed shoulder arthroplasty to reverse total shoulder arthroplasty. The study included 26 patients (mean age, 68.46 years) with failed shoulder arthroplasty who underwent conversion to reverse total shoulder arthroplasty with a minimum 2-year follow-up (mean, 34.38 months). Patients who had retention of the humeral stem were compared with those who had stem revision. Humeral stem retention was associated with a significantly shorter operative time (178.92 vs 237 minutes, P=.02). Decreases in blood loss, complications, and length of hospitalization were observed, but the differences were not statistically significant. Minimal differences were observed for patient-reported outcomes. Of patients undergoing humeral stem removal, 21.4% had an intraoperative humeral shaft or tuberosity fracture compared with none in the stem retention group. Humeral stem retention was associated with decreased operative time compared with humeral stem revision in the conversion of failed shoulder arthroplasty to reverse total shoulder arthroplasty. The use of a platform shoulder arthroplasty system may benefit patients with failed shoulder arthroplasty undergoing conversion to reverse total shoulder arthroplasty by avoiding humeral stem revision. PMID:26375534

  9. In Vitro Bioactivity Study of RGD-Coated Titanium Alloy Prothesis for Revision Total Hip Arthroplasty

    PubMed Central

    Man, Zhentao; Sha, Dan; Sun, Shui; Li, Tao; Li, Bin; Yang, Guang; Wu, Changshun; Jiang, Peng

    2016-01-01

    Total hip arthroplasty (THA) is a common procedure for the treatment of end-stage hip joint disease, and the demand for revision THA will double by 2026. Ti6Al4V (Titanium, 6% Aluminum, and 4% Vanadium) is a kind of alloy commonly used to make hip prothesis. To promote the osseointegration between the prothesis and host bone is very important for the revision THA. The peptide Arg-Gly-Asp (RGD) could increase cell attachment and has been used in the vascular tissue engineering. In this study, we combined the RGD with Ti6Al4V alloy using the covalent cross-linking method to fabricate the functional Ti6Al4V alloy (FTA). The distribution of RGD oligopeptide on the FTA was even and homogeneous. The FTA scaffolds could promote mouse osteoblasts adhesion and spreading. Furthermore, the result of RT-qPCR indicated that the FTA scaffolds were more beneficial to osteogenesis, which may be due to the improvement of osteoblast adhesion by the RGD oligopeptide coated on FTA. Overall, the FTA scaffolds developed herein pave the road for designing and building more efficient prothesis for osseointegration between the host bone and prothesis in revision THA. PMID:27493968

  10. In Vitro Bioactivity Study of RGD-Coated Titanium Alloy Prothesis for Revision Total Hip Arthroplasty.

    PubMed

    Man, Zhentao; Sha, Dan; Sun, Shui; Li, Tao; Li, Bin; Yang, Guang; Zhang, Laibo; Wu, Changshun; Jiang, Peng; Han, Xiaojuan; Li, Wei

    2016-01-01

    Total hip arthroplasty (THA) is a common procedure for the treatment of end-stage hip joint disease, and the demand for revision THA will double by 2026. Ti6Al4V (Titanium, 6% Aluminum, and 4% Vanadium) is a kind of alloy commonly used to make hip prothesis. To promote the osseointegration between the prothesis and host bone is very important for the revision THA. The peptide Arg-Gly-Asp (RGD) could increase cell attachment and has been used in the vascular tissue engineering. In this study, we combined the RGD with Ti6Al4V alloy using the covalent cross-linking method to fabricate the functional Ti6Al4V alloy (FTA). The distribution of RGD oligopeptide on the FTA was even and homogeneous. The FTA scaffolds could promote mouse osteoblasts adhesion and spreading. Furthermore, the result of RT-qPCR indicated that the FTA scaffolds were more beneficial to osteogenesis, which may be due to the improvement of osteoblast adhesion by the RGD oligopeptide coated on FTA. Overall, the FTA scaffolds developed herein pave the road for designing and building more efficient prothesis for osseointegration between the host bone and prothesis in revision THA. PMID:27493968

  11. Cementless total knee arthroplasty with Profix: a 8- to 10-year follow-up study.

    PubMed

    Hardeman, François; Vandenneucker, Hilde; Van Lauwe, Johan; Bellemans, Johan

    2006-12-01

    A consecutive series of 115 cementless Profix (Smith and Nephew, Memphis, USA) Total Knee Arthroplasties performed in 113 patients were followed in order to determine the functional results and survivorship at 8 to 10 years. All patients were included in a prospective database and were reviewed annually until final follow-up. Patients overall satisfaction was excellent or good in 91.3% of cases. The mean Knee Society's knee and function scores increased respectively from 49.3 and 36.7 preoperatively to 93.1 and 82.2 postoperatively. The Kaplan-Meier estimate of implant survival at 10 years was 97.1%. Two patients underwent revision and were considered as failures. One patient had a fracture of the medial condyle at 4 days post-surgery, and the other was revised for aseptic loosening of the tibial component at 6 years post-surgery. On the basis of this long-term follow-up study, we can conclude that the Profix Total Knee System is effective and safe. PMID:17064905

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

    PubMed Central

    Huch, K; Muller, K; Sturmer, T; Brenner, H; Puhl, W; Gunther, K

    2005-01-01

    Objective: To analyse sports activities of patients with hip or knee osteoarthritis (OA) over lifetime, preoperatively, and 5 years after arthroplasty. Methods: In a longitudinal four centre study, 809 consecutive patients with advanced OA of the hip (420) or the knee (389) joint under the age of 76 years who required total joint replacement were recruited. A completed questionnaire about sports activities at 5 year follow up was received from 636 (79%) of the 809 patients. Results: Although most patients with hip (97%) and knee (94%) OA had performed sports activities during their life, only 36% (hip patients) and 42% (knee patients) had maintained sports activities at the time of surgery. Five years postoperatively, the proportion of patients performing sports activities increased to 52% among patients with hip OA, but further declined to 34% among those with knee OA. Accordingly, the proportion of patients with hip OA performing sports activities for more than 2 hours a week increased from 8 to 14%, whereas this proportion decreased from 12 to 5% among patients with knee OA. Pain in the replaced joint was reported by 9% of patients with hip and by >16% with knee OA. Conclusion: Differences in pain 5 years after joint replacement may explain some of the difference of sports activities between patients with hip and knee OA. Reasons for reduction of sports activities may include the increasing age of the patients, their worries about an "artificial joint", and the advice of their surgeon to be cautious. PMID:15843453

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

    PubMed

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

    2015-10-01

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

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

    PubMed Central

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

    2015-01-01

    Purpose this study was conducted to investigate the influence of the popliteus tendon (PT) on the static stability of total knee arthroplasty (TKA). Methods twenty knees were used. In 10 right knees, a cruciate-retaining (CR) TKA trial prosthesis was implanted; in the other ten knees (left knees), the posterior cruciate ligament was cut and a posterior substitution (PS) TKA trial prosthesis was implanted. Lamina spreaders were set at 100 N of tension, one on the medial and one on the lateral articular space. Gaps were then measured with a caliper before and after PT sectioning. Results the correlation between femoral dimensions and popliteus insertion distance from articular surfaces was measured with the Pearson correlation index and considered significant. In the CR-TKA group, medial and lateral gap measurements showed a significant increase after PT sectioning both in flexion and in extension. In the PS-TKA group, lateral gap measurements showed a significant increase after PT sectioning both in flexion and in extension, while the medial gap measurements increased significantly only in flexion. Conclusions PT sectioning destabilized both the lateral and the medial aspects of the knee. A greater effect was observed in the lateral compartment. The most statistically reliable effect was observed with the knee in flexion. In addition, we observed that preserving the PCL does not prevent lateral gap opening after PT sectioning. Clinical relevance PT should always be preserved when performing a TKA, because its resection can affect gap balancing, in flexion and in extension. Type of study controlled laboratory study. PMID:26151034

  15. Survey Criteria for Fibromyalgia Independently Predict Increased Postoperative Opioid Consumption after Lower Extremity Joint Arthroplasty: A Prospective, Observational Cohort Study

    PubMed Central

    Brummett, Chad M.; Janda, Allison M.; Schueller, Christa M.; Tsodikov, Alex; Morris, Michelle; Williams, David A.; Clauw, Daniel J.

    2013-01-01

    Background Variance in pain following total knee and hip arthroplasty may be due to a number of procedural and peripheral factors but also, in some individuals, to aberrant central pain processing as is described in conditions like fibromyalgia. To test this hypothesis, we conducted a prospective, observational cohort study of patients undergoing lower extremity joint arthroplasty. Methods 519 patients were preoperatively phenotyped using validated self-reported pain questionnaires, psychological measures, and health information. In addition to assessing factors previously found to be associated with poor outcomes in arthroplasty, participants also completed the American College of Rheumatology survey criteria for fibromyalgia. Previous studies have suggested that rather than being “present” or “absent,” features of fibromyalgia as measured by this instrument, occur over a wide continuum. Postoperative pain control was assessed by total postoperative opioid consumption. Results Preoperatively, patients with higher fibromyalgia survey scores were younger, more likely to be female, taking more opioids, reported higher pain severity, and had a more negative psychological profile. In the multivariate analysis, the fibromyalgia survey score, younger age, preoperative opioid use, knee (vs. hip), pain severity at baseline, and the anesthetic technique were all predictive of increased postoperative opioid consumption. Conclusions Using the survey criteria for fibromyalgia distinct phenotypic differences were found, and the measure was independently predictive of opioid consumption. This self-report measure may provide an additional simple means of predicting postoperative pain outcomes and analgesic requirements. Future studies are needed to determine whether tailored therapies can improve postoperative pain control in this population. PMID:24343289

  16. Venous Thromboembolism Following Hip and Knee Replacement Arthroplasty in Korea: A Nationwide Study Based on Claims Registry.

    PubMed

    Lee, Sahnghoon; Hwang, Jee-In; Kim, Yunjung; Yoon, Pil Whan; Ahn, Jeonghoon; Yoo, Jeong Joon

    2016-01-01

    The aim of this study was to examine the incidence and trends of clinically relevant venous thromboembolism (VTE) including deep vein thrombosis (DVT) and pulmonary embolism (PE) after hip and knee replacement arthroplasty (HKRA) in Korea. Between January 1 and December 31, 2010, 22,127 hip replacement arthroplasty (HRA) patients and 52,882 knee replacement arthroplasty (KRA) patients were enrolled in the analysis using the administrative claims database of the Health Insurance Review and Assessment Service (HIRA). All available parameters including procedure history and clinically relevant VTE during the 90 days after HKRA were identified based on diagnostic and electronic data interchange (EDI) codes. The overall incidence of VTE, DVT, and PE during the 90 days was 3.9% (n=853), 2.7% (n=597), and 1.5% (n=327) after HRA, while the incidence was 3.8% (n=1,990), 3.2% (n=1,699), and 0.7% (n=355) after KRA. The incidence of VTE after HKRA was significantly higher in patients who had previous VTE history (odds ratio [OR], 10.8 after HRA, OR, 8.5 after KRA), chronic heart failure (2.1, 1.3), arrhythmia (1.8, 1.7), and atrial fibrillation (3.4, 2.1) than in patients who did not. The VTE incidence in patients with chemoprophylaxis was higher than that in patients without chemoprophylaxis. The incidence of VTEs revealed in this retrospective review was not low compared with the results of the studies targeting other Asian or Caucasian populations. It may warrant routine prevention including employment of chemoprophylaxis. However, the limitation of the reviewed data mandates large scale prospective investigation to affirm this observation. PMID:26770042

  17. A comprehensive joint replacement program for total knee arthroplasty: a descriptive study

    PubMed Central

    Cook, Jon R; Warren, Meghan; Ganley, Kathleen J; Prefontaine, Paul; Wylie, Jack W

    2008-01-01

    Background Total knee arthroplasty (TKA) is a commonly performed surgical procedure in the US. It is important to have a comprehensive inpatient TKA program which maximizes outcomes while minimizing adverse events. The purpose of this study was to describe a TKA program – the Joint Replacement Program (JRP) – and report post-surgical outcomes. Methods 74 candidates for a primary TKA were enrolled in the JRP. The JRP was designed to minimize complications and optimize patient-centered outcomes using a team approach including the patient, patient's family, and a multidisciplinary team of health professionals. The JRP consisted of a pre-operative class, standard pathways for medical care, comprehensive peri-operative pain management, aggressive physical therapy (PT), and proactive discharge planning. Measures included functional tests, knee range of motion (ROM), and medical record abstraction of patient demographics, length of stay, discharge disposition, and complications over a 6-month follow-up period. Results All patients achieved medical criteria for hospital discharge. The patients achieved the knee flexion ROM goal of 90° (91.7 ± 5.4°), but did not achieve the knee extension ROM goal of 0° (2.4 ± 2.6°). The length of hospital stay was two days for 53% of the patients, with 39% and 7% discharged in three and four days, respectively. All but three patients were discharged home with functional independence. 68% of these received outpatient physical therapy compared with 32% who received home physical therapy immediately after discharge. Two patients (< 3%) had medical complications during the inpatient hospital stay, and 9 patients (12%) had complications during the 6-month follow-up period. Conclusion The comprehensive JRP for TKA was associated with satisfactory clinical outcomes, short lengths of stay, a high percentage of patients discharged home with outpatient PT, and minimal complications. This JRP may represent an efficient, effective and safe

  18. Cost benefit analysis of the use of tranexamic acid in primary lower limb arthroplasty: A retrospective cohort study

    PubMed Central

    McGoldrick, Niall P; O’Connor, Eabhann M; Davarinos, Nikos; Galvin, Rose; Quinlan, John F

    2015-01-01

    AIM: To examine the cost benefit conferred by the perioperative administration of intravenous tranexamic acid (TXA) in lower limb arthroplasty. METHODS: This study evaluates the use of TXA in 200 consecutive lower limb arthroplasties performed in a single surgeon series. The initial 100 patients (control group) underwent surgery without perioperative administration of TXA while the subsequent 100 patients (TXA group) all received 1 g TXA at the time of induction of anaesthesia. Pre- and post-operative haemoglobin, platelet count, haematocrit, the use of blood product post-operatively, length of stay were examined. A financial analysis of both groups was then undertaken. RESULTS: The mean age of patients in both groups was 63 ± 13 years. There were no significant differences between groups in terms of gender (P = 0.47), proportion of total hip replacement to total knee replacement (P = 0.25) or pre-operative haemoglobin (P = 0.43). In the control group, the transfusion rate was 22%. In the TXA group, the transfusion rate dropped to 2% (P < 0.001). The mean post-operative haemoglobin was 10.82 ± 1.55 g/dL in the control group vs 11.33 ± 1.27 g/dL in the TXA group (P = 0.01). The total cost of transfused blood products was €11055 and €603 respectively. The mean length of stay in the control group was 6.53 ± 5.93 d vs 5.47 ± 4.26 d in the TXA group (P = 0.15) leading to an estimated financial saving of €114586. There was one pulmonary embolus in the control group and one deep venous thrombosis in the TXA group. CONCLUSION: Intravenous TXA reduces blood loss in lower limb arthroplasty. This leads to lower transfusion rates, shorter length of stay in hospital and significant financial savings. PMID:26716094

  19. Robotic-assisted knee arthroplasty.

    PubMed

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

    2015-01-01

    Robotics in total knee arthroplasty (TKA) has undergone vast improvements. Although some of the systems have fallen out of favor due to safety concerns, there has been recent increased interest for semi-active haptic robotic systems that provide intraoperative tactile feedback to the surgeon. The potential advantages include improvements in radiographic outcomes, reducing the incidence of mechanical axis malalignment of the lower extremity and better tissue balance. Proponents of robotic technology believe that these improvements may lead to superior functional outcomes and implant survivorship. We aim to discuss robotic technology development, outcomes of unicompartmental and total knee arthroplasty and the future outlook. Short-term follow-up studies on robotic-assisted knee arthroplasty suggest that, although some alignment objectives may have been achieved, more studies regarding functional outcomes are needed. Furthermore, studies evaluating the projected cost-benefit analyses of this new technology are needed before widespread adoption. Nevertheless, the short-term results warrant further evaluation. PMID:26365088

  20. Prospective evaluation of criteria for microbiological diagnosis of prosthetic-joint infection at revision arthroplasty. The OSIRIS Collaborative Study Group.

    PubMed

    Atkins, B L; Athanasou, N; Deeks, J J; Crook, D W; Simpson, H; Peto, T E; McLardy-Smith, P; Berendt, A R

    1998-10-01

    A prospective study was performed to establish criteria for the microbiological diagnosis of prosthetic joint infection at elective revision arthroplasty. Patients were treated in a multidisciplinary unit dedicated to the management and study of musculoskeletal infection. Standard multiple samples of periprosthetic tissue were obtained at surgery, Gram stained, and cultured by direct and enrichment methods. With reference to histology as the criterion standard, sensitivities, specificities, and likelihood ratios (LRs) were calculated by using different cutoffs for the diagnosis of infection. We performed revisions on 334 patients over a 17-month period, of whom 297 were evaluable. The remaining 37 were excluded because histology results were unavailable or could not be interpreted due to underlying inflammatory joint disease. There were 41 infections, with only 65% of all samples sent from infected patients being culture positive, suggesting low numbers of bacteria in the samples taken. The isolation of an indistinguishable microorganism from three or more independent specimens was highly predictive of infection (sensitivity, 65%; specificity, 99.6%; LR, 168.6), while Gram staining was less useful (sensitivity, 12%; specificity, 98%; LR, 10). A simple mathematical model was developed to predict the performance of the diagnostic test. We recommend that five or six specimens be sent, that the cutoff for a definite diagnosis of infection be three or more operative specimens that yield an indistinguishable organism, and that because of its low level of sensitivity, Gram staining should be abandoned as a diagnostic tool at elective revision arthroplasty.

  1. I-ONE therapy in patients undergoing total knee arthroplasty: a prospective, randomized and controlled study

    PubMed Central

    2012-01-01

    Background Total knee arthroplasty (TKA) is often associated with a severe local inflammatory reaction which, unless controlled, leads to persistent pain up to one year after surgery. Standard and accelerated rehabilitation protocols are currently being implemented after TKA, but no consensus exists regarding the long-term effects. Biophysical stimulation with pulsed electromagnetic fields (PEMFs) has been demonstrated to exert an anti-inflammatory effect, to promote early functional recovery and to maintain a positive long-term effect in patients undergoing joint arthroscopy. The aim of this study was to evaluate whether PEMFs can be used to limit the pain and enhance patient recovery after TKA. Methods A prospective, randomized, controlled study in 30 patients undergoing TKA was conducted. Patients were randomized into experimental PEMFs or a control group. Patients in the experimental group were instructed to use I-ONE stimulator 4hours/day for 60days. Postoperatively, all patients received the same rehabilitation program. Treatment outcome was assessed using the Knee Society Score, SF-36 Health-Survey and VAS. Patients were evaluated pre-operatively and one, two, six and 12 months after TKA. Joint swelling and Non Steroidal Anti Inflammatory Drug (NSAID) consumption were recorded. Comparisons between the two groups were carried out using a two-tail heteroschedastic Student’s t-test. Analysis of variance for each individual subject during the study was performed using ANOVA for multiple comparisons, applied on each group, and a Dunnet post hoc test. A p value < 0.05 was considered statistically significant. Results Pre-operatively, no differences were observed between groups in terms of age, sex, weight, height, Knee-Score, VAS, SF-36 and joint swelling, with the exception of the Functional Score. The Knee-Score, SF-36 and VAS demonstrated significantly positive outcomes in the I-ONE stimulated group compared with the controls at follow-ups. In the I

  2. Inequalities in use of total hip arthroplasty for hip fracture: population based study

    PubMed Central

    Metcalfe, David; Griffin, Xavier L; Costa, Matthew L

    2016-01-01

    Objectives To determine whether the use of total hip arthroplasty (THA) among individuals with a displaced intracapsular fracture of the femoral neck is based on national guidelines or if there are systematic inequalities. Design Observational cohort study using the National Hip Fracture Database (NHFD). Setting All hospitals that treat adults with hip fractures in England, Wales, and Northern Ireland. Participants Patients within the national database (all aged ≥60) who received operative treatment for a non-pathological displaced intracapsular hip fracture from 1 July 2011 to 31 April 2015. Main outcome measures Provision of THA to patients considered eligible under criteria published by the National Institute for Health and Care Excellence (NICE). Results 114 119 patients with hip fracture were included, 11 683 (10.2%) of whom underwent THA. Of those who satisfied the NICE criteria, 32% (6780)received a THA. Of patients who underwent THA, 42% (4903) did not satisfy the NICE criteria. A recursive partitioning algorithm found that the NICE eligibility criteria did not optimally explain which patients underwent THA. A model with superior explanatory power drew distinctions that are not supported by NICE, which were an age cut off at 76 and a different ambulation cut off. Among patients who satisfied the NICE eligibility, the use of THA was less likely with higher age (odds ratio 0.88, 95% confidence interval 0.87 to 0.88), worsening abbreviated mental test scores (0.49 (0.41 to 0.58) for normal cognition v borderline cognitive impairment)), worsening American Society of Anesthesiologists score (0.74, 0.66 to 0.84), male sex (0.85, 0.77 to 0.93), worsening ambulatory status (0.32, 0.28 to 0.35 for walking with a stick v independent ambulation), and fifths of worsening socioeconomic area deprivation (0.76 (0.66 to 0.88) for least v most deprived fifth). Patients receiving treatment during the working week were more likely to receive THA than at the

  3. Biofeedback to Promote Movement Symmetry After Total Knee Arthroplasty: A Feasibility Study

    PubMed Central

    ZENI, JOSEPH; ABUJABER, SUMAYAH; FLOWERS, PORTIA; POZZI, FEDERICO; SNYDER-MACKLER, LYNN

    2014-01-01

    STUDY DESIGN Prospective analysis of a longitudinal cohort with an embedded comparison group at a single time point. OBJECTIVES To determine the feasibility and effectiveness of an outpatient rehabilitation protocol that includes movement symmetry biofeedback on functional and biomechanical outcomes after total knee arthroplasty (TKA). BACKGROUND TKA reduces pain and improves functional ability, but many patients experience strength deficits and movement abnormalities in the operated limb, despite outpatient rehabilitation. These asymmetries increase load on the nonoperated limb, and greater asymmetry is related to worse functional outcomes. METHODS Biomechanical and functional metrics were assessed 2 to 3 weeks prior to TKA, at discharge from outpatient physical therapy, and 6 months after TKA in 11 patients (9 men, 2 women; mean ± SD age, 61.4 ± 5.8 years; body mass index, 33.1 ± 5.4 kg/m2) who received 6 to 8 weeks of outpatient physical therapy that included specialized symmetry training. Six-month outcomes were compared to a control group, matched by age, body mass index, and sex (9 men, 2 women; mean ± SD age, 61.8 ± 5 years; body mass index, 34.3 ± 5.1 kg/m2), that did not receive specialized symmetry retraining. RESULTS Of the 11 patients who received added symmetry training, 9 demonstrated clinically meaningful improvements that exceeded the minimal detectable change for all performance-based functional tests at 6 months post-TKA compared to pre-TKA. Six months after TKA, when walking, patients who underwent symmetry retraining had greater knee extension during midstance and had mean sagittal knee moments that were more symmetrical, biphasic, and more representative of normal knee kinetics compared to patients who did not undergo symmetry training. No patients experienced adverse events as the result of the protocol. CONCLUSION Adding symmetry retraining to postoperative protocols is clinically viable, safe, and may have additional benefits compared

  4. Bilateral anatomic total shoulder arthroplasty versus reverse shoulder arthroplasty.

    PubMed

    Latif, Vaqar; Denard, Patrick J; Young, Allan A; Liotard, Jean-Pierre; Walch, Gllies

    2012-04-01

    The results of anatomic total shoulder arthroplasty and reverse shoulder arthroplasty have previously been reported separately. Although the indications differ, scenarios exist in which a patient may have a total shoulder arthroplasty on 1 shoulder and a reverse shoulder arthroplasty on the contralateral shoulder.Between 1992 and 2009, twelve patients underwent bilateral sequential primary shoulder arthroplasty with a total shoulder arthroplasty on 1 side and reverse shoulder arthroplasty on the contralateral side. Constant score, American Shoulder and Elbow Surgeons (ASES) score, subjective shoulder value, and patient satisfaction were obtained a minimum 1 year postoperatively. Mean postoperative Constant score was 77 after total shoulder arthroplasty and 73 after reverse shoulder arthroplasty (P<.2488). Mean postoperative active forward flexion was similar after total shoulder arthroplasty compared with reverse shoulder arthroplasty (P=.8910). Greater external rotation at the side (43° vs 12°; P<.0001) and internal rotation (T8 vs L1; P<.0001) were observed after total shoulder arthroplasty. Mean ASES score was 89.6 after total shoulder arthroplasty compared with 82.4 after reverse shoulder arthroplasty (P=.0125). Patient satisfaction was 92% for both prostheses, and mean subjective shoulder value was similar (85.4% vs 82.5%; P=.6333).Bilateral shoulder arthroplasty performed with a total shoulder arthroplasty and reverse shoulder arthroplasty on opposite shoulders can provide good functional outcome and high patient satisfaction. Although range of motion is better following total shoulder arthroplasty, no difference was observed in final Constant score or subjective patient assessment. PMID:22495846

  5. Failure of aseptic revision total knee arthroplasties

    PubMed Central

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

    2015-01-01

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

  6. Vibroacoustography for the assessment of total hip arthroplasty

    PubMed Central

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

    2013-01-01

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

  7. Tantalum acetabular augments in one-stage exchange of infected total hip arthroplasty: a case-control study.

    PubMed

    Klatte, Till Orla; Kendoff, Daniel; Sabihi, Reza; Kamath, Atul F; Rueger, Johannes M; Gehrke, Thorsten

    2014-07-01

    During the one-stage exchange procedure for periprosthetic joint infection (PJI) after total hip arthroplasty (THA), acetabular defects challenge reconstructive options. Porous tantalum augments are an established tool for addressing acetabular destruction in aseptic cases, but their utility in septic exchange is unknown. This retrospective case-control study presents the initial results of tantalum augmentation during one-stage exchange for PJI. Primary endpoints were rates of re-infection and short-term complications associated with this technique. Study patients had no higher risk of re-infection with equivalent durability at early follow-up with a re-infection rate in both groups of 4%. In conclusion, tantalum augments are a viable option for addressing acetabular defects in one-stage exchange for septic THA. Further study is necessary to assess long-term durability when compared to traditional techniques for acetabular reconstruction.

  8. Two Gifted Rapid Readers--Preliminary Study.

    ERIC Educational Resources Information Center

    Schale, Florence C.

    The "page-at-a-glance" reading phenomenon in two gifted readers using only monocular vision was investigated. The specific questions to be answered in this preliminary study were (1) What is the average duration of fixations made by gifted readers while reading a somewhat familiar article? and (2) What degree of comprehension on materials of…

  9. Total shoulder arthroplasty outcome for treatment of osteoarthritis: a multicenter study using a contemporary implant.

    PubMed

    Wright, Thomas W; Flurin, Pierre-Henri; Crosby, Lynn; Struk, Aimee M; Zuckerman, Joseph D

    2015-11-01

    In this article, we present clinical results of primary total shoulder arthroplasty for osteoarthritis using an implant that provides dual eccentricity and variable neck and version angles for reconstruction of proximal humeral anatomy. Two hundred one patients with symptomatic osteoarthritis underwent 218 total shoulder arthroplasties with a fourth-generation anatomical shoulder and a replicator plate at 4 centers between August 1, 2006, and December 31, 2010. Fourth-generation implants allow for varying humeral neck and version angles and have dual eccentricity so as to be consistently able to cover the humeral head cut. At a mean follow-up of 3 years (minimum, 2 years), there was an 81% follow-up rate. At final follow-up, 3 objective measures were significantly (P < .05) improved over preoperative levels: average active elevation (preoperative, 92°; postoperative, 137°), active external rotation (pre, 15°; post, 42°), and active internal rotation (pre, S3; post, L2). The functional outcome scores that were significantly (P < .05) improved at final follow-up were Constant normalized (pre, 39; post, 79), Shoulder Pain and Disability Index (pre, 86; post, 20), Simple Shoulder Test (pre, 3.3; post, 10), UCLA Shoulder Rating Scale (pre, 13; post, 31), and American Shoulder and Elbow Surgeons Shoulder Assessment (pre, 33; post, 85). Complications were noted in 11% of the shoulders. The most common complications were rotator cuff failure (13, 6%) and infection (5, 2%). PMID:26566554

  10. Preliminary study for the OFFELO

    SciTech Connect

    Hao, Y.; Litvinenko, V.N.

    2010-08-23

    X-ray Optics-Free FEL Oscillator (OFFELO) has potential of becoming a choice for next generation light sources. Using electron beam for the feedback allows OFFELO to be completely tunable and to combine the peak power of high-gain SASE FELs with extremely narrow bandwidth of the oscillator. While the high-gain X-ray FELs has been studied in depth and has been successfully demonstrated, two other concepts (the transport and the feed-back) involved in OFFELO still need detail studies. In this short paper we focus on the simulation of the feedback process and the evolution of FEL spectrum in X-ray OFFELO. In our initial studies of OFFELO studied the saturation of the system and also its evolution using Genesis 2.0 code with a homemade wrapping code. While and lattice design from the modulator to the radiator, in order to minimize the feedback information loss in transporting the beam.

  11. Preliminary design study of lunar housing configurations

    NASA Technical Reports Server (NTRS)

    Reynolds, K. H.

    1992-01-01

    A preliminary design study assesses various configurations for habitation of the lunar surface. The study assumes an initial 4-man habitation module expandable to a 48-man concept. Through the numerous coupling combinations of identical modules, five basic configuration types are identified. A design model presents each configuration in light of certain issues. The issues include circulation, internal and external spatial characteristics, functional organizations, and future growth potential. The study discusses the attributes, potentials, and unique requirements of each configuration.

  12. Biomechanical and histologic investigation of cemented total hip arthroplasties. A study of autopsy-retrieved femurs after in vivo cycling.

    PubMed

    Maloney, W J; Jasty, M; Burke, D W; O'Connor, D O; Zalenski, E B; Bragdon, C; Harris, W H

    1989-12-01

    Eleven whole anatomic specimens of the femur were retrieved at autopsy from patients who previously had cemented total hip arthroplasty. Implant duration ranged from 0.5 to 210 months. Clinically and roentgenographically the implants were stable. A detailed biomechanical analysis evaluated bone strains and implant stability in both the single-limb stance and stair-climbing positions using a 100-pound spinal load. The stability offered by cement in these well-fixed prostheses was remarkable, with the maximum axial micromotion being 40 mu. This is a reflection of intimate osseointegration at the bone-cement interface with only rare intervening fibrous tissue. The strain gauge and photoelastic strain-coating studies revealed that marked stress shielding in the proximal medial femoral cortex persists long after a cemented femoral component is inserted. Even 17 years after surgery, the strain in the calcar region did not normalize. PMID:2582664

  13. Cuban Identity: A Preliminary Study.

    ERIC Educational Resources Information Center

    Alvarez, Carlos; Bliss, Linda A.; Vigil, Peter

    This study explored patterns of differences and commonalities in the constructions of identity by Cuban Americans, focusing on the pain of their experiencing "Paradise Lost," a theme identified in earlier research in which Cuban American college students reported: strong Cuban connections; value for the Spanish language, food, and culture; and a…

  14. Worker Motivation Study: Preliminary Analysis.

    ERIC Educational Resources Information Center

    Fulton, Margaret A.

    Since the Hawthorne Studies gave birth to the human relations approach to management, employee motivation, defined as an intervening variable(s) that accounts for factors within an individual that arouse, maintain, and channel behavior toward a goal, has been of much interest. An attempt was made to replicate the factor structure of the Wherry and…

  15. Computer-assisted navigation in knee arthroplasty: a critical appraisal.

    PubMed

    Venkatesan, Muralidharan; Mahadevan, Devendra; Ashford, Robert U

    2013-10-01

    The purpose of this review was to appraise the use of computer-assisted navigation in total knee arthroplasty and to assess whether this technology has improved clinical outcomes. Studies were identified through searches in MEDLINE, Embase, and PubMed. Numerous studies have shown improved leg and component alignment using navigation systems. However, the better alignment achieved in navigated knee arthroplasty has not been shown to lead to better clinical outcomes. Navigated knee arthroplasty had lower calculated blood loss and lower incidence of fat embolism compared with conventional knee arthroplasty using intramedullary jigs. It may be most valued when dealing with complex knee deformities, revision surgery, or minimally invasive surgery. Navigated knee arthroplasty, however, is only cost-effective in centers with a high volume of joint replacements. Overall, computer-assisted navigated knee arthroplasty provides some advantages over conventional surgery, but its clinical benefits to date are unclear and remain to be defined on a larger scale.

  16. Transition from nerve blocks to periarticular injections and emerging techniques in total joint arthroplasty.

    PubMed

    Springer, Bryan D

    2014-10-01

    The emergence of procedure-specific multimodal pain management regimens that provide effective control of postoperative pain, while markedly reducing the amount of opioid medication required, has been one of the most important advances in hip and knee replacement in recent years. When peripheral nerve blockade first became widely available for inclusion in multimodal regimens, it was viewed as a revolution in the management of postoperative pain. This approach, however, is costly and has some important limitations, including an increased incidence of falls. For many patients, peripheral nerve blocks can now be replaced by a periarticular injection with EXPAREL® (bupivacaine liposome injectable suspension), an extended-release anesthetic infiltrated by the surgeon as part of a multimodal pain regimen. EXPAREL® offers some important clinical and administrative benefits over nerve blocks. Preliminary data from a pilot study comparing the relative effectiveness of EXPAREL® versus sciatic nerve blockade has shown a noticeable reduction in average pain scores at rest with EXPAREL® following both hip and knee arthroplasty, as well as a reduction in the 6- to 12-hour pain score following hip arthroplasty. There was also a significant reduction in opioid use with EXPAREL®, as well as a $411 reduction in the cost of total knee arthroplasty and a $348 reduction in the cost of total hip arthroplasty.

  17. Total Shoulder Arthroplasty

    PubMed Central

    Sanchez-Sotelo, Joaquin

    2011-01-01

    Shoulder arthroplasty has been the subject of marked advances over the last few years. Modern implants provide a wide range of options, including resurfacing of the humeral head, anatomic hemiarthroplasty, total shoulder arthroplasty, reverse shoulder arthroplasty and trauma-specific implants for fractures and nonunions. Most humeral components achieve successful long-term fixation without bone cement. Cemented all-polyethylene glenoid components remain the standard for anatomic total shoulder arthroplasty. The results of shoulder arthroplasty vary depending on the underlying diagnosis, the condition of the soft-tissues, and the type of reconstruction. Total shoulder arthroplasty seems to provide the best outcome for patients with osteoarthritis and inflammatory arthropathy. The outcome of hemiarthroplasty for proximal humerus fractures is somewhat unpredictable, though it seems to have improved with the use of fracture-specific designs, more attention to tuberosity repair, and the selective use of reverse arthroplasty, as well as a shift in indications towards internal fixation. Reverse shoulder arthroplasty has become extremely popular for patients with cuff-tear arthropathy, and its indications have been expanded to the field of revision surgery. Overall, shoulder arthroplasty is a very successful procedure with predictable pain relief and substantial improvements in motion and function. PMID:21584206

  18. Time Trends in Total Ankle Arthroplasty in the U.S.: A Study of the Nationwide Inpatient Sample

    PubMed Central

    Singh, Jasvinder A.; Ramachandaran, Rekha

    2014-01-01

    Objective To assess the time-trends in utilization, clinical characteristics and outcomes of patients undergoing total ankle arthroplasty (TAA) in the U.S. Methods We used the Nationwide Inpatient Sample (NIS) data from 1998 to 2010 to examine time-trends in the utilization rates of TAA. We used the Cochran Armitage test for trend to assess time-trends across the years and the analysis of variance (ANOVA), Wilcoxon test or chi-squared test (as appropriate) to compare the first (1998–2000) and the last time periods (2009–10). Results TAA utilization rate increased significant from 1998 to 2010: 0.13 to 0.84 per 100,000 overall, 0.14 to 0.88 per 100,000 in females and from 0.11 to 0.81 per 100,000 in males (p<0.0001 for each comparison for time-trends). Compared to the 1998–2000, those undergoing TAA in 2009–10: were older (41% fewer patients <50 years, p<0.0001); less likely to have RA as the underlying diagnosis (55% fewer patients, p=0.0001); more likely to have Deyo-Charlson index of two or more (197% more, p=0.0010); and had a shorter length of stay at 2.5 days (17% reduction, p<0.0001). Mortality was rare, ranging 0 to 0.6% and discharge to inpatient facility ranged 12.6–14.1%; we noted no significant time-trends in either (p>0.05). Conclusions The utilization rate of TAA increased rapidly in the U.S. from 1998 to 2010, but post-arthroplasty mortality rate was stable. Underlying diagnosis and medical comorbidity changed over time and both can impact outcomes after TAA. Further studies should examine how the outcomes and complications of TAA have evolved over time. PMID:24907036

  19. The effect of high tibial osteotomy on the results of total knee arthroplasty: a matched case control study

    PubMed Central

    van Raaij, Tom M; Bakker, Wouter; Reijman, Max; Verhaar, Jan AN

    2007-01-01

    Background We performed a matched case control study to assess the effect of prior high tibia valgus producing osteotomy on results and complications of total knee arthroplasty (TKA). Methods From 1996 until 2003 356 patients underwent all cemented primary total knee replacement in our institution. Twelve patients with a history of 14 HTO were identified and matched to a control group of 12 patients with 14 primary TKA without previous HTO. The match was made for gender, age, date of surgery, body mass index, aetiology and type of prosthesis. Clinical and radiographic outcome were evaluated after a median duration of follow-up of 3.7 years (minimum, 2.3 years). The SPSS program was used for statistical analyses. Results The index group had more perioperative blood loss and exposure difficulties with one tibial tuberosity osteotomy and three patients with lateral retinacular releases. No such procedures were needed in the control group. Mid-term HSS, KSS and WOMAC scores were less favourable for the index group, but these differences were not significant. The tibial slope of patients with prior HTO was significantly decreased after this procedure. The tibial posterior inclination angle was corrected during knee replacement but posterior inclination was significantly less compared to the control group. No deep infection or knee component loosening were seen in the group with prior HTO. Conclusion We conclude that TKA after HTO seems to be technically more demanding than a primary knee arthroplasty, but clinical outcome was almost identical to a matched group that had no HTO previously. PMID:17683549

  20. Vascular complications following total hip arthroplasty: a case study and a review of the literature.

    PubMed

    Barbier, Olivier; Pierret, Charles; Bazile, Fabrice; De Kerangal, Xavier; Duverger, Vincent; Versier, Gilbert

    2012-11-01

    Vascular complications after total hip arthroplasty (THA) are rare but represent a real risk. The diversity of clinical presentations can make diagnosis difficult. They could manifest as an immediate and acute hemorrhage or subsequent ischemia. We report the case of a patient who presented a thrombosis of the femoral artery associated with a sciatic palsy after THA for a coxa profunda. The diagnosis was actually made 3 years after surgery because of atypical symptoms. The mechanism involved was either a crash of the artery by a retractor on the anterior wall of the acetabulum, or a stretching of the artery. A review of the literature of vascular complications occurring after THA recalls the multiplicity of clinical presentations and the diagnostic difficulties. They could manifest as an immediate and acute hemorrhage or deferred ischemia, as in our case. Knowledge of these complications should help prevent them, and the diagnosis should be considered in atypical sequences after THA.

  1. Standard Transgluteal versus Minimal Invasive Anterior Approach in hip Arthroplasty: A Prospective, Consecutive Cohort Study

    PubMed Central

    Ilchmann, Thomas; Gersbach, Silke; Zwicky, Lukas; Clauss, Martin

    2013-01-01

    A minimally invasive anterior approach (MIS) was compared to a standard lateral approach in primary total hip arthroplasty. Clinical and radiological outcomes were analyzed 6 weeks, 12 weeks, one year and two years after surgery. The duration of surgery was longer, mobility one week after surgery was better and time of hospitalization was shorter for minimally invasive-treated patients. They had less pain during movement, limping, better Harris Hip Score and satisfaction after 6 weeks, which remained after 12 weeks and 1 year, but not after two years. There were two deep infections in the MIS group. Radiological results were not affected. The infections might be a point of concern, but there were no other disadvantages of the MIS approach. In fact, early rehabilitation was facilitated and clinical results were improved. Our results encourage the continuous use of the MIS anterior approach instead of the lateral approach. PMID:24416475

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

    ClinicalTrials.gov

    2016-05-11

    Osteoarthritis; Rheumatoid Arthritis; Post-traumatic Arthritis; Ununited Humeral Head Fracture; Irreducible 3-and 4-part Proximal Humeral Fractures; Avascular Necrosis; Gross Rotator Cuff Deficiency; Failed Total Shoulder Arthroplasty (Both Glenoid and Humeral Components Require Revision

  3. Return to sports after shoulder arthroplasty

    PubMed Central

    Johnson, Christine C; Johnson, Daniel J; Liu, Joseph N; Dines, Joshua S; Dines, David M; Gulotta, Lawrence V; Garcia, Grant H

    2016-01-01

    Many patients prioritize the ability to return to sports following shoulder replacement surgeries, including total shoulder arthroplasty (TSA), reverse total shoulder arthroplasty (RTSA), and hemiarthroplasty (HA). While activity levels after hip and knee replacements have been well-established in the literature, studies on this topic in the field of shoulder arthroplasty are relatively limited. A review of the literature regarding athletic activity after shoulder arthroplasty was performed using the PubMed database. All studies relevant to shoulder arthroplasty and return to sport were included. The majority of patients returned to their prior level of activity within six months following TSA, RTSA, and shoulder HA. Noncontact, low demand activities are permitted by most surgeons postoperatively and generally have higher return rates than contact sports or high-demand activities. In some series, patients reported an improvement in their ability to participate in sports following the arthroplasty procedure. The rates of return to sports following TSA (75%-100%) are slightly higher than those reported for HA (67%-76%) and RTSA (75%-85%). Patients undergoing TSA, RTSA, and shoulder HA should be counseled that there is a high probability that they will be able to return to their preoperative activity level within six months postoperatively. TSA has been associated with higher rates of return to sports than RTSA and HA, although this may reflect differences in patient population or surgical indication.

  4. Return to sports after shoulder arthroplasty.

    PubMed

    Johnson, Christine C; Johnson, Daniel J; Liu, Joseph N; Dines, Joshua S; Dines, David M; Gulotta, Lawrence V; Garcia, Grant H

    2016-09-18

    Many patients prioritize the ability to return to sports following shoulder replacement surgeries, including total shoulder arthroplasty (TSA), reverse total shoulder arthroplasty (RTSA), and hemiarthroplasty (HA). While activity levels after hip and knee replacements have been well-established in the literature, studies on this topic in the field of shoulder arthroplasty are relatively limited. A review of the literature regarding athletic activity after shoulder arthroplasty was performed using the PubMed database. All studies relevant to shoulder arthroplasty and return to sport were included. The majority of patients returned to their prior level of activity within six months following TSA, RTSA, and shoulder HA. Noncontact, low demand activities are permitted by most surgeons postoperatively and generally have higher return rates than contact sports or high-demand activities. In some series, patients reported an improvement in their ability to participate in sports following the arthroplasty procedure. The rates of return to sports following TSA (75%-100%) are slightly higher than those reported for HA (67%-76%) and RTSA (75%-85%). Patients undergoing TSA, RTSA, and shoulder HA should be counseled that there is a high probability that they will be able to return to their preoperative activity level within six months postoperatively. TSA has been associated with higher rates of return to sports than RTSA and HA, although this may reflect differences in patient population or surgical indication. PMID:27672564

  5. Return to sports after shoulder arthroplasty

    PubMed Central

    Johnson, Christine C; Johnson, Daniel J; Liu, Joseph N; Dines, Joshua S; Dines, David M; Gulotta, Lawrence V; Garcia, Grant H

    2016-01-01

    Many patients prioritize the ability to return to sports following shoulder replacement surgeries, including total shoulder arthroplasty (TSA), reverse total shoulder arthroplasty (RTSA), and hemiarthroplasty (HA). While activity levels after hip and knee replacements have been well-established in the literature, studies on this topic in the field of shoulder arthroplasty are relatively limited. A review of the literature regarding athletic activity after shoulder arthroplasty was performed using the PubMed database. All studies relevant to shoulder arthroplasty and return to sport were included. The majority of patients returned to their prior level of activity within six months following TSA, RTSA, and shoulder HA. Noncontact, low demand activities are permitted by most surgeons postoperatively and generally have higher return rates than contact sports or high-demand activities. In some series, patients reported an improvement in their ability to participate in sports following the arthroplasty procedure. The rates of return to sports following TSA (75%-100%) are slightly higher than those reported for HA (67%-76%) and RTSA (75%-85%). Patients undergoing TSA, RTSA, and shoulder HA should be counseled that there is a high probability that they will be able to return to their preoperative activity level within six months postoperatively. TSA has been associated with higher rates of return to sports than RTSA and HA, although this may reflect differences in patient population or surgical indication. PMID:27672564

  6. Porous tantalum tibial component prevents periprosthetic loss of bone mineral density after total knee arthroplasty for five years-a matched cohort study.

    PubMed

    Minoda, Yukihide; Kobayashi, Akio; Ikebuchi, Mitsuhiko; Iwaki, Hiroyoshi; Inori, Fumiaki; Nakamura, Hiroaki

    2013-12-01

    In 21 knees receiving porous tantalum tibial component and 21 knees receiving a cemented cobalt-chromium tibial component, dual x-ray absorptiometry scans were performed for five years post-operatively. The postoperative decrease in the bone mineral density in the lateral aspect of the tibia was significantly less in knees with porous tantalum tibial components (11.6%) than in knees with cemented cobalt-chromium tibial components (29.6%) at five years (p < 0.05). No prosthetic migration or periprosthetic fracture was detected in either group. The present study is one of the studies with the longest follow-up period on bone mineral density after total knee arthroplasty. Porous tantalum tibial component has a favorable effect on the bone mineral density of the proximal tibia after total knee arthroplasty up to five years.

  7. Emerging Indications for Reverse Shoulder Arthroplasty.

    PubMed

    Urch, Ekaterina; Dines, Joshua S; Dines, David M

    2016-01-01

    Historically, reverse shoulder arthroplasty was reserved for older, low-demand patients in whom rotator cuff arthropathy was diagnosed. Other common indications included sequelae of previously treated proximal humerus fractures, failed anatomic total shoulder arthroplasty, tumor resection, and rheumatoid arthritis in the elderly population. Unpredictable implant durability and high complication rates have limited the use of reverse shoulder arthroplasty to a narrow group of patients. Over the past decade, however, research has led to an improved understanding of the biomechanics behind reverse shoulder prostheses, which has improved implant design and surgical techniques. Consequently, orthopaedic surgeons have slowly begun to expand the indications for reverse shoulder arthroplasty to include a wider spectrum of shoulder pathologies. Recent studies have shown promising results for patients who undergo reverse shoulder arthroplasty for the treatment of acute proximal humerus fractures, massive rotator cuff tears without arthropathy, primary osteoarthritis, and chronic anterior dislocation, as well as for younger patients who have rheumatoid arthritis. These data suggest that, with judicious patient selection, reverse shoulder arthroplasty can be an excellent treatment option for a growing patient cohort. PMID:27049188

  8. The Kaiser Permanente Shoulder Arthroplasty Registry

    PubMed Central

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

    2015-01-01

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

  9. Electromagnetic navigation in total knee arthroplasty-a single center, randomized, single-blind study comparing the results with conventional techniques.

    PubMed

    Blyth, Mark J G; Smith, Julie R; Anthony, Iain C; Strict, Neville E; Rowe, Philip J; Jones, Bryn G

    2015-02-01

    We report on the results of a randomized study (n=200) to compare total knee arthroplasty performed using conventional instrumentation or electromagnetic computer assisted surgical technique. 92% of navigated and 85% of conventional knees were implanted within ±3° from neutral mechanical alignment; there was no statistically significant difference between these proportions. There was also no difference in femoral or tibial rotation assessed by CT scan. At 1year follow up there was no statistical difference between the two groups in American Knee Society Score, Oxford Knee Scores, patient satisfaction, quality of life, hospital length of stay, complication rates or other adverse events. Tourniquet time in the navigated group was longer. Proving value for navigation in total knee arthroplasty surgery remains a challenge.

  10. The acetabulum: A prospective study of three-phase bone and indium white blood cell scintigraphy following porous-coated hip arthroplasty

    SciTech Connect

    Oswald, S.G.; Van Nostrand, D.; Savory, C.G.; Anderson, J.H.; Callaghan, J.J. )

    1990-03-01

    Although few studies address the use of three-phase bone scanning (TPBS) and indium-111-labeled white blood cell scintigraphy ({sup 111}In-WBC) in hip arthroplasty utilizing a porous-coated prosthesis, the literature suggests that scintigraphic patterns in the uncomplicated patient may differ from that seen with the cemented prosthesis. In an attempt to determine the scintigraphic natural history, 25 uncomplicated porous-coated hip arthroplasties in 21 patients were prospectively studied with serial TPBS and {sup 111I}n-WBC at approximately 7 days, and 3, 6, 12, 18, and 24 mo postoperatively. This report deals with findings related to the acetabulum. All 25 prostheses (144 of 144 scans) demonstrated increased uptake on the bone-phase images. Although this activity decreased with time, 76% had persistent uptake at 24 mo. Twenty-three of 25 prostheses (126 of 140 scans) showed increased uptake on {sup 111}In-WBC scintigraphy, invariably decreasing with time, but with 37% having significant uptake at 24 mo. Scintigraphic patterns in the uncomplicated porous-coated hip arthroplasty patient appear to differ from patterns described in cemented prostheses.

  11. A clinical study of the rotational alignment of the femoral component in total knee arthroplasty

    PubMed Central

    Ding, Liangjia; Liu, Xiaomin; Liu, Changlu; Liu, Yingli

    2015-01-01

    [Purpose] The reasons for femorotibial rotational malalignment after total knee arthroplasty (TKA) were analyzed to provide evidence for clinical knee joint surgery and to reduce complications. [Subjects and Methods] Ninety knees of 60 patients were selected and randomly divided into two groups (n=30). For one group, rotational alignment of the femoral component was determined by the transepicondylar axis and TKA was performed. For the other group, rotational alignment of the femoral component was conducted through 3° external rotation of the posterior femoral condyles. Knee joint specimens were operated with TKA and various biomechanical indices were measured. [Results] The femoral epicondylar axis was a constant, reliable reference for femoral component rotational alignment. When the femoral component was rotated by 0° versus the epicondylar axis, the peak contact pressure on the patellofemoral joint was optimal. When the femoral component was arranged in parallel with Whiteside’s line, the peak contact pressure on the patellofemoral joint varied largely. The patellofemoral contact areas of the two groups were similar. [Conclusion] Axial rotational alignment of the femoral component influenced the contact pressure of patellofemoral joints in TKA more significantly than external rotation of the femoral condyles. It is more reliable to use the femoral epicondylar axis as the reference for the rotational alignment of the femoral component. PMID:26311929

  12. Risk factors for pulmonary embolism after hip and knee arthroplasty: a population-based study

    PubMed Central

    Besculides, Melanie C.; Gaber, Licia; Liu, Spencer; González Della Valle, Alejandro

    2008-01-01

    Pulmonary embolism (PE) is a cause of death after total hip and knee arthroplasty (THA, TKA). We characterised the patient population suffering from in-hospital PE and identified perioperative risk factors associated with PE using nationally representative data. Data from the National Hospital Discharge Survey between 1990 and 2004 on patients who underwent primary or revision THA/TKA in the United States were analysed. Multivariate regression analysis was performed to determine if perioperative factors were associated with increased risk of in-hospital PE. An estimated 6,901,324 procedures were identified. The incidence of in-hospital PE was 0.36%. Factors associated with an increased risk for the diagnosis of PE included: revision THA, female gender, dementia, obesity, renal and cerebrovascular disease. An increased association with PE was found among patients with diagnosis of Adult Respiratory Distress Syndrome (ARDS), psychosis (confusion), and peripheral thrombotic events. Our findings may be useful in stratifying the individual patient’s risk of PE after surgery. PMID:18925395

  13. Preliminary study of contaminant particulates around Skylab

    NASA Technical Reports Server (NTRS)

    Schuerman, D. W.; Weinberg, J. L.

    1976-01-01

    Techniques originally developed for the Skylab T025 contamination experiment were applied to S052 white-light coronagraph data in a preliminary study to investigate particulates around Skylab. Periods were selected which contained some contamination, even though there were no apparent dumps or vents during these periods. Velocity and size distributions were determined from optical data for particles within 200 meters of the spacecraft. Both photographic (61 particle tracks) and video (34 particles) observations yield an upper limit on particle radius of 100 micrometers. Selected photometric data from the S073 zodiacal light experiment during mission SL-2 were also examined for evidence of contamination.

  14. A Finite-Element Study of Metal Backing and Tibial Resection Depth in a Composite Tibia Following Total Knee Arthroplasty.

    PubMed

    Tokunaga, Susumu; Rogge, Renee D; Small, Scott R; Berend, Michael E; Ritter, Merrill A

    2016-04-01

    Prosthetic alignment, patient characteristics, and implant design are all factors in long-term survival of total knee arthroplasty (TKA), yet the level at which each of these factors contribute to implant loosening has not been fully described. Prior clinical and biomechanical studies have indicated tibial overload as a cause of early TKA revision. The purpose of this study was to determine the relationship between tibial component design and bone resection on tibial loading. Finite-element analysis (FEA) was performed after simulated implantation of metal backed (MB) and all-polyethylene (AP) TKA components in 5 and 15 mm of tibial resection into a validated intact tibia model. Proximal tibial strains significantly increased between 13% and 199% when implanted with AP components (p < 0.05). Strain significantly increased between 12% and 209% in the posterior tibial compartment with increased bone resection (p < 0.05). This study indicates elevated strains in AP implanted tibias across the entirety of the proximal tibial cortex, as well as a posterior shift in tibial loading in instances of increased resection depth. These results are consistent with trends observed in prior biomechanical studies and may associate the documented device history of tibial collapse in AP components with increased bone strain and overload beneath the prosthesis. PMID:26810930

  15. Outcomes Following Radial Head Arthroplasty.

    PubMed

    Fowler, John R; Henry, Sarah E; Xu, Peter; Goitz, Robert J

    2016-05-01

    Most current series of radial head arthroplasty include small numbers of patients with short- to medium-term follow-up and significant heterogeneity in patients, treatments, and outcome measures. The purpose of this systematic review was to review outcomes for radial head arthroplasty based on injury chronicity, injury pattern, and type of implant used. The authors systematically searched electronic databases for studies containing radial head arthroplasty or radial head replacement and identified 19 studies for inclusion in the analysis. For each included study, a composite mean was obtained for Mayo Elbow Performance Score (MEPS) and range of motion. Outcomes were said to differ significantly if their confidence intervals did not overlap. The MEPS for acute treatment (90) was higher than that for delayed treatment (81). There was no difference in the pooled MEPS between the isolated (89) and complex injury pattern (87) groups or implant material. There was no difference in range of motion between the acute and delayed or isolated and complex groups, but the average degree of pronation was higher in patients treated with titanium implants (76°) compared with cobalt chromium implants (66°). This systematic review suggests that outcomes are improved following acute arthroplasty for treatment of radial head fractures compared with delayed treatment, based on MEPS. The lack of other significant differences detected is likely due to the significant heterogeneity and inadequate power in current studies. Further prospective studies isolating the different variables will be needed to determine their true effect on outcomes. [Orthopedics. 2016; 39(3):153-160.]. PMID:27045484

  16. Expression of keratan sulfate at the arthroplasty surface after cup arthroplasty.

    PubMed

    Yamada, H; Kikuchi, T; Morita, M; Henmi, O; Fujikawa, K; Washimi, O; Terada, N; Seki, T

    2000-01-01

    Fibrous tissue which regenerated on the acetabular arthroplasty surface was obtained from a 52-year-old woman who underwent total hip replacement after cup arthroplasty. The histological features of this newly formed fibrous tissue and expression of keratan sulfate, which is a characteristic matrix component of articular cartilage, were studied. Microscopic observation revealed that the arthroplasty surface consisted mainly of fibrous tissue which did not show metachromasia with toluidine blue staining, but there were many nodular structures communicating with the bone marrow. Immunostaining for keratan sulfate revealed clear positive staining around the cells of the nodular structures communicating with the bone marrow, while only weakly positive staining was observed in the superficial layer of the loose fibrous tissue. The present study revealed marked formation of articular cartilaginous tissue in areas having good communication with the bone marrow, which indicates that maintenance of this communication may be necessary to improve the outcome of cup arthroplasty.

  17. [Cementless total hip arthroplasty--results of 8-year follow-up study].

    PubMed

    Wall, Andrzej; Dragan, Szymon

    2006-01-01

    The subjects of the clinical examinations were 382 patients who from 1994 to 1999 were treated with the method of total cementless arthroplasty. The observation time ranged from 3 to 8 years. In the examined group the secondary cause of degenerative changes was identified in 210 (55%) patients. In the remaining 172 cases (45%) the primary cause of degenerative changes in the hip was diagnosed. Four types of cementless endoprostheses, varied in their construction, structure of their surfaces and material they were made of, were used to carry out the postoperative treatment of the degenerative changes in the hip: Antega, Zweymüller SL PLUS (Endoprosthetic) or Alloclasic type of stem, GSS-CL and PM-Plasmapore. The findings of the clinical investigation made it possible to determine the probability of surviving of an endoprosthesis up to the 8th year after an operation depending on a type of implanted stem, which according to Kaplan-Meier's method, amounted to 0.9603. The results of Harris scale evaluation of the function of the operated joints demonstrated the existence of the relationship between the function and the course of bone osteointegration and growth process. The detailed analysis of the X-ray examinations, and especially of the roentgenometric ones, taking into account stability of the endoprosthesis stem enabled to distinguish two stages of the clinical and roentgenological changes: the early stage (up to 6 months after an operation) characterised by settling and micromotions of the stem and the late stage (starting 6-9 months after an operation) with slowly gradual increasing of the function and holding back of stem settling. PMID:17017478

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

    PubMed Central

    Trumble, Thomas; Rafijah, Gregory; Heaton, Dennis

    2013-01-01

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

  19. Preliminary Results of Implantation in Animal Model and Osteoblast Culture Evaluation of Prototypes of Biomimetic Multispiked Connecting Scaffold for Noncemented Stemless Resurfacing Hip Arthroplasty Endoprostheses

    PubMed Central

    Uklejewski, Ryszard; Rogala, Piotr; Winiecki, Mariusz; Kędzia, Andrzej; Ruszkowski, Piotr

    2013-01-01

    We present the new fixation method for RHA (resurfacing hip arthroplasty) endoprostheses by means of the biomimetic multispiked connecting scaffold (MSC-Scaffold). Such connecting scaffold can generate new type of RHA endoprostheses, that is stemless and fixed entirely without cement. The preprototypes of this MSC-Scaffold were manufactured with modern additive laser additive technology (SLM). The pilot surgical implantations in animal model (two laboratory swine) of MSC-Scaffold preprototypes have showed after two months neither implant loosening, migration, and nor other early complications. From the results of performed histopathological evaluation of the periscaffold spikes bone tissue and 10-day culture of human osteoblasts (NHOst) we can conclude that (1) the scaffolding effect was obtained and (2) to improve the osseointegration of the scaffold spikes, their material surface should be physicochemically modified (e.g., with hydroxyapatite). Some histopathological findings in the periscaffold domain near the MSC-Scaffold spikes bases (fibrous connective tissue and metallic particles near the MSC-Scaffold spikes bases edges) prompt considering the necessity to optimize the design of the MSC-Scaffold in the regions of its interspike space near the spikes bases edges, to provide more room for new bone formation in this region and for indispensable post-processing (glass pearl blasting) after the SLM manufacturing. PMID:23984397

  20. Can Total Wrist Arthroplasty Be an Option for Treatment of Highly Comminuted Distal Radius Fracture in Selected Patients? Preliminary Experience with Two Cases

    PubMed Central

    Schmidt, Ingo

    2015-01-01

    We present two case reports of successful primary shortening of the forearm and total wrist arthroplasty (TWA) using the new angle-stable Maestro Wrist Reconstructive System (WRS) for treatment of highly comminuted distal radius fracture in selected autonomous patients. In a 56-year-old male patient with adequate bone stock, insertion of the noncemented Maestro WRS was combined with ulnar shortening osteotomy. In an 84-year-old female patient with poor osteoporotic bone stock, insertion of the radial cemented Maestro WRS was combined with ulnar head resection. Both patients could resume their work without additional surgery after TWA. At the 1-year follow-up, there were no changes in position of either implant without signs of loosening, no impingement, and no instability of the distal radioulnar joint or the distal ulna stump. All clinical parameters (DASH score, pain through VAS, and grip strength) were satisfactory. Both patients reported that they would have the same procedure again. Further experience is needed to validate this concept. PMID:26491587

  1. A preliminary neutron crystallographic study of thaumatin

    SciTech Connect

    Teixeira, Susana C. M.; Blakeley, Matthew P.; Leal, Ricardo M. F.; Mitchell, Edward P.; Forsyth, V. Trevor

    2008-05-01

    Preliminary neutron crystallographic data from the sweet protein thaumatin have been recorded using the LADI-III diffractometer at the Institut Laue Langevin (ILL). The results illustrate the feasibility of a full neutron structural analysis aimed at further understanding the molecular basis of the perception of sweet taste. Such an analysis will exploit the use of perdeuterated thaumatin. A preliminary neutron crystallographic study of the sweet protein thaumatin is presented. Large hydrogenated crystals were prepared in deuterated crystallization buffer using the gel-acupuncture method. Data were collected to a resolution of 2 Å on the LADI-III diffractometer at the Institut Laue Langevin (ILL). The results demonstrate the feasibility of a full neutron crystallographic analysis of this structure aimed at providing relevant information on the location of H atoms, the distribution of charge on the protein surface and localized water in the structure. This information will be of interest for understanding the specificity of thaumatin–receptor interactions and will contribute to further understanding of the molecular mechanisms underlying the perception of taste.

  2. Microsection analysis of cortical form-fit of a custom femoral component in total hip arthroplasty: an in vitro study

    PubMed Central

    Leichtle, Ulf Gunther; Leichtle, Carmen Ina; Martini, Franz

    2012-01-01

    Custom femoral components have been developed for total hip arthroplasty to maximize cortical form-fit and thereby to reduce the problems of stress shielding and aseptic loosening. Limited information is available about how much endosteal cortical contact can actually be achieved with these expensive implants. The aim of this study was therefore to verify the exact cortical contact of a custom made stem using microsections and comparing it to a standard stem with similar design. In 8 human femurs (3 matched pairs and 2 separate specimens), custom femoral prostheses (Adaptiva; 5 femurs: 3 matched and 2 separate) and conventional femoral prostheses (Alloclassic; 3 matched femurs) were implanted. Endosteal cortical contact was determined from CAD planning drafts and microsections cut from the specimens with a diamond saw. Microsection analysis of the paired femurs showed that contact between prosthesis and bone varied clearly along the length of the femoral stem. Total cortical contact was considerably greater in custom prostheses than conventional prostheses (custom, 47%; conventional, 32%), but markedly less than the total contact predicted by the manufacturer (84% to 90%). The custom prosthesis had more lateral cortical contact on CAD planning drafts (cortical contact: medial, 60%; lateral, 53%) than on specimen microsections after implantation (medial, 64%; lateral, 24%). In summary, the philosophy of anchorage of both prostheses types could be confirmed. However, areas of cortical contact of the custom made prosthesis were considerably smaller compared to the pre-operative planning. PMID:23066498

  3. A comparative microstructural study of vitamin-E blended and infused highly crosslinked UHMWPE for total knee arthroplasty.

    PubMed

    Puppulin, Leonardo; Leto, Andrea; Hasegawa, Masahiro; Pezzotti, Giuseppe

    2014-11-01

    The impact of adding antioxidant vitamin-E (α-tocopherol) to the microstructure of ultrahigh molecular weight polyethylene (UHMWPE) for total knee arthroplasty has been studied in detail by means of Raman microprobe spectroscopy. Three tibial insert samples prepared by different manufacturing methods were investigated, as follows: (A) a sample manufactured without blending with vitamin E which did not receive any irradiation dose after consolidation but underwent final sterilization in ethylene oxide (EtO); (B) a sample blended with 0.3 wt% of α-tocopherol, an isomer of vitamin E, and manufactured as sample (A); and, (C) a sample in which vitamin E was diffused after being irradiated with 100 kGy dose of γ-ray. Clear microstructural differences were observed in terms of phase contents (i.e., amorphous, crystalline, and intermediate phase fraction), molecular orientation, and the degree of anisotropy between the investigated tibial plates. Vitamin E in the starting resin promoted chain mobility leading to reorganization of the molecular chains. The spectroscopic characterizations helps to rationalize the complex effect of vitamin-E on the UHMWPE microstructure and gives useful information on how significantly any single step of the manufacturing procedures might affect the mechanical properties of the final orthopedic component. PMID:25151446

  4. Sports Activity after Low-contact-stress Total Knee Arthroplasty - A long term follow-up study.

    PubMed

    Vielgut, Ines; Leitner, Lukas; Kastner, Norbert; Radl, Roman; Leithner, Andreas; Sadoghi, Patrick

    2016-04-19

    The purpose of this study was to provide comprehensive long-term data about sports activity levels in patients following total knee arthroplasty (TKA) and to determine the impact of pre-operative function, pain and specific performed sports on the results. 236 patients who have undergone TKA for severe osteoarthritis of the knee were asked to provide specific information regarding exercised types of sports before surgery and after at least 10 years following TKA. Pre- and postoperative function and pain were evaluated by the use of Tegner-, WOMAC- and VAS Score. After a mean of 14.9 years, a significant improvement regarding pain and function was observed. Pre-operative Tegner- and WOMAC scores revealed significant positive correlations with the post-operative Tegner-Score. Accordingly, a high percentage of patients (70.9%) stayed actively involved in sports. Nevertheless, the number of performing patients has decreased according to the sports impact. 71.3% continued practising low-impact-, 43.7% intermediate-impact sports whereas only 16.4% kept performing high impact sports. We conclude that TKA is highly effective in long-time pain reduction as well as improvement of function. Additionally, we found considerable sports activities preserved in the investigated series. However, sports activities in particular, seem to decrease according to the impact of sports.

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

    PubMed

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

    2014-05-01

    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.

  6. A comparative microstructural study of vitamin-E blended and infused highly crosslinked UHMWPE for total knee arthroplasty.

    PubMed

    Puppulin, Leonardo; Leto, Andrea; Hasegawa, Masahiro; Pezzotti, Giuseppe

    2014-11-01

    The impact of adding antioxidant vitamin-E (α-tocopherol) to the microstructure of ultrahigh molecular weight polyethylene (UHMWPE) for total knee arthroplasty has been studied in detail by means of Raman microprobe spectroscopy. Three tibial insert samples prepared by different manufacturing methods were investigated, as follows: (A) a sample manufactured without blending with vitamin E which did not receive any irradiation dose after consolidation but underwent final sterilization in ethylene oxide (EtO); (B) a sample blended with 0.3 wt% of α-tocopherol, an isomer of vitamin E, and manufactured as sample (A); and, (C) a sample in which vitamin E was diffused after being irradiated with 100 kGy dose of γ-ray. Clear microstructural differences were observed in terms of phase contents (i.e., amorphous, crystalline, and intermediate phase fraction), molecular orientation, and the degree of anisotropy between the investigated tibial plates. Vitamin E in the starting resin promoted chain mobility leading to reorganization of the molecular chains. The spectroscopic characterizations helps to rationalize the complex effect of vitamin-E on the UHMWPE microstructure and gives useful information on how significantly any single step of the manufacturing procedures might affect the mechanical properties of the final orthopedic component.

  7. Sports Activity after Low-contact-stress Total Knee Arthroplasty – A long term follow-up study

    PubMed Central

    Vielgut, Ines; Leitner, Lukas; Kastner, Norbert; Radl, Roman; Leithner, Andreas; Sadoghi, Patrick

    2016-01-01

    The purpose of this study was to provide comprehensive long-term data about sports activity levels in patients following total knee arthroplasty (TKA) and to determine the impact of pre-operative function, pain and specific performed sports on the results. 236 patients who have undergone TKA for severe osteoarthritis of the knee were asked to provide specific information regarding exercised types of sports before surgery and after at least 10 years following TKA. Pre- and postoperative function and pain were evaluated by the use of Tegner-, WOMAC- and VAS Score. After a mean of 14.9 years, a significant improvement regarding pain and function was observed. Pre-operative Tegner- and WOMAC scores revealed significant positive correlations with the post-operative Tegner-Score. Accordingly, a high percentage of patients (70.9%) stayed actively involved in sports. Nevertheless, the number of performing patients has decreased according to the sports impact. 71.3% continued practising low-impact-, 43.7% intermediate-impact sports whereas only 16.4% kept performing high impact sports. We conclude that TKA is highly effective in long-time pain reduction as well as improvement of function. Additionally, we found considerable sports activities preserved in the investigated series. However, sports activities in particular, seem to decrease according to the impact of sports. PMID:27090945

  8. Examination of rotational fixation of the femoral component in total hip arthroplasty. A mechanical study of micromovement and acoustic emission.

    PubMed

    Sugiyama, H; Whiteside, L A; Kaiser, A D

    1989-12-01

    Rotational loosening has recently emerged as an important cause of failure of the femoral component of total hip arthroplasties. This study was designed to investigate the role played by torsional loads in loosening of cementless femoral components and to evaluate three cementing techniques involving a combination of canal irrigation, manual insertion, and vacuum mixing combined with pressure injection of the cement for their ability to improve rotational fixation. Rotational micromotion and subsidence were measured in 24 preserved human anatomic specimen femora. Acoustic emission (AE) technique was applied as a non-destructive method for evaluating material failure during loading. From the micromovement data, torque to 50 mu subsidence and torque to failure were surprisingly low with cementless fixation and with poor cement technique but were markedly improved with pulsed irrigation. Further improvement was achieved by pressure injection and vacuum mixing of the cement. However, AE was detected even in the most carefully performed cement specimens under torsional-loading conditions commonly occurring in daily activities. These signs of microfailure of the cement mantle at relatively low torsional loads suggest that the mode of failure of deeply penetrated cement is by microfracture of the cement mantle. The poor performance suggests that cementless fixation of intramedullary stems provides unsatisfactory fixation against torsional loading. There is need for major improvements in fixation mechanisms and techniques. The signs of failure of the cement mantle at normally occurring torsional loads suggest that even the best cement technique is prone to failure in torsion when exposed to normal daily use. PMID:2582663

  9. Knee arthroplasty rating.

    PubMed

    Binazzi, R; Soudry, M; Mestriner, L A; Insall, J N

    1992-06-01

    A number of rating systems used to evaluate the results of total knee arthroplasty exist. Many of these systems are based on different concepts, and might be expected to give divergent results. To see if this was so, the authors examined a consecutive series of 235 posterior stabilized knee arthroplasties recording the results according to five rating systems: HSS (The Hospital for Special Surgery), Brigham, Freeman, BOA (British Orthopaedic Association), and the VENN diagram. In spite of their apparent differences, all point systems and the BOA gave almost identical results, while the VENN diagram proved to be the most stringent. The authors suggest that any of the current point systems may be used to "score" arthroplasties, but the results should also be rated with the VENN diagram in order to see the quality of the arthroplasty and a comparison between the different series.

  10. Monitoring Adverse Drug Reactions: A Preliminary Study

    PubMed Central

    Reynolds, J. L.

    1981-01-01

    The feasibility of family physicians functioning as monitors of adverse drug reactions (ADR) was examined over one month in ten practices. This was done as a preliminary trial, before attempting to use the 200 family physicians of the National Reporting System of the College of Family Physicians of Canada to monitor ADRs on a national basis. Both of these trials were designed to examine the feasibility of family physicians acting as prospective monitors of ADRs in newly marketed drugs and to identify a drug group suitable for monitoring. This study examined the detection of ADRs, prescribing and practice profiles. No firm conclusion could be reached as to the value of family doctors monitoring ADRs. This study supports the evidence that older patients receive more drugs and are at even greater risk of an ADR. Antibiotics, cardiovascular, anti-inflammatory or antidepressant drugs are suggested as those most suitable for prospective monitoring in a family practice setting. PMID:21289786

  11. Polyethylene Wear in Knee Arthroplasty.

    PubMed

    Chakravarty, Rajit; Elmallah, Randa D K; Cherian, Jeffrey Jai; Kurtz, Steven M; Mont, Michael A

    2015-10-01

    Polyethylene (PE) wear and osteolysis are common causes for late revisions of knee arthroplasties. Several implant and surgical factors have been implicated in contributing to the development of wear, such as type of bearing surface used, inaccurate articular geometry, and poor knee kinematics. In addition, patient-related factors, such as younger age and higher activity levels, may also contribute to wear. Our purpose was to evaluate and compare the effect of these variables on wear rates following knee arthroplasty. Recently, technological advancements have been aimed at reducing the incidence of wear by improving the PE manufacturing process, creating implants that minimize contact stresses, and refining our surgical techniques. Furthermore, the development of newer highly cross-linked PEs (HXLPEs) and the introduction of additives, such as vitamin E, to the PEs may improve overall implant survivorship. As a result, with the advent of newer implant and PE designs, wear is no longer the most common cause of early failure, though it remains an important factor in limiting long-term implant survivorship. However, there are a few clinical studies evaluating the long-term outcomes of newer HXLPEs and implant designs, with further evaluations necessary to determine the best implant-PE combination for improved knee arthroplasty survivorship. PMID:26030263

  12. Reverse-total shoulder arthroplasty cost-effectiveness: A quality-adjusted life years comparison with total hip arthroplasty

    PubMed Central

    Bachman, Daniel; Nyland, John; Krupp, Ryan

    2016-01-01

    AIM: To compare reverse-total shoulder arthroplasty (RSA) cost-effectiveness with total hip arthroplasty cost-effectiveness. METHODS: This study used a stochastic model and decision-making algorithm to compare the cost-effectiveness of RSA and total hip arthroplasty. Fifteen patients underwent pre-operative, and 3, 6, and 12 mo post-operative clinical examinations and Short Form-36 Health Survey completion. Short form-36 Health Survey subscale scores were converted to EuroQual Group Five Dimension Health Outcome scores and compared with historical data from age-matched patients who had undergone total hip arthroplasty. Quality-adjusted life year (QALY) improvements based on life expectancies were calculated. RESULTS: The cost/QALY was $3900 for total hip arthroplasty and $11100 for RSA. After adjusting the model to only include shoulder-specific physical function subscale items, the RSA QALY improved to 2.8 years, and its cost/QALY decreased to $8100. CONCLUSION: Based on industry accepted standards, cost/QALY estimates supported both RSA and total hip arthroplasty cost-effectiveness. Although total hip arthroplasty remains the quality of life improvement “gold standard” among arthroplasty procedures, cost/QALY estimates identified in this study support the growing use of RSA to improve patient quality of life. PMID:26925384

  13. The evaluation of the failed shoulder arthroplasty.

    PubMed

    Wiater, Brett P; Moravek, James E; Wiater, J Michael

    2014-05-01

    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.

  14. Impromptu Speaking and Interpretation Studies: A Preliminary Study

    ERIC Educational Resources Information Center

    Heinz, Michael

    2013-01-01

    The purpose of this preliminary study was to look at forensics-based competition events and determine what, if any, impact they could have on the language learning and public speaking skills of interpreters in training. This paper details the nature of the impromptu and extemporaneous speaking events in forensics competitions and introduces a…

  15. Bone mineral density of the proximal femur after hip resurfacing arthroplasty: 1-year follow-up study

    PubMed Central

    2011-01-01

    Background Hip resurfacing arthroplasty (HRA) is considered a bone-preserving procedure and may eliminate proximal femoral stress shielding and osteolysis. However, in addition to implant-related stress-shielding factors, various patient-related factors may also have an effect on bone mineral density (BMD) of the proximal femur in patients with HRA. Thus, we studied the effects of stem-neck angle, demographic variables, and physical functioning on the BMD of the proximal femur in a one-year follow-up. Methods Thirty three patients (9 females and 24 males) with a mean (SD) age of 55 (9) years were included in the study. BMD was measured two days and 3, 6, and 12 months postoperatively and 10 regions of interest (ROI) were used. Stem-neck angle was analyzed from anteroposterior radiographs. Results Three months postoperatively, BMD decreased in six out of 10 regions of interest (ROI) on the side operated on and in one ROI on the control side (p < 0.05) compared to the second postoperative day. At 12 months, BMD had increased in 7 ROIs on the operated side and one ROI on the control side (all p < 0.001). Correlation was found between the stem-neck angle and BMD in ROIs 2, 3, 7, and 9 (r = 0.36 - 0.61). In multiple regression analysis, stem-neck angle, age, sex, body mass index, and walking distance did not explain the BMD changes. Conclusions After an early drop, the BMD of the upper femur was restored and even exceeded the preoperative level at one year follow-up. From a clinical standpoint, the changes in BMD in these HRA patients could not be explained by stem-neck angle or patient related factors. PMID:21595913

  16. Smoking and Risk of Prosthesis-Related Complications after Total Hip Arthroplasty: A Meta-Analysis of Cohort Studies

    PubMed Central

    Teng, Songsong; Yi, Chengqing; Krettek, Christian; Jagodzinski, Michael

    2015-01-01

    Objective Increasing evidence suggests that smoking may increase the incidence of prosthesis-related complications after total hip arthroplasty (THA). We performed a meta-analysis of cohort studies to quantitatively evaluate the association between smoking and the risk of prosthesis-related complications after THA. Methods Relevant articles published before August 15, 2014, were identified by searching the PubMed, EMBASE and Cochrane library databases. Pooled risk ratios (RRs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated with either a fixed- or random-effects model. Results Six cohort studies, involving a total of 8181 participants, were included in the meta-analysis. Compared with the patients who never smoked, smokers had a significantly increased risk of aseptic loosening of prosthesis (summary RR=3.05, 95% CI: 1.42-6.58), deep infection (summary RR=3.71, 95% CI: 1.86-7.41) and all-cause revisions (summary RR=2.58, 95% CI: 1.27-5.22). However, no significant difference in the risk of implant dislocation (summary RR= 1.27, 95% CI: 0.77-2.10) or length of hospital stay (WMD=0.03, 95% CI: -0.65-0.72) was found between smokers and nonsmokers. Conclusions Smoking is associated with a significantly increased risk of aseptic loosening of prosthesis, deep infection and all-cause revisions after THA, but smoking is not correlated with a risk of implant dislocation or the length of hospital stay after surgery. PMID:25909602

  17. Mouse model of chronic post-arthroplasty infection: noninvasive in vivo bioluminescence imaging to monitor bacterial burden for long-term study.

    PubMed

    Pribaz, Jonathan R; Bernthal, Nicholas M; Billi, Fabrizio; Cho, John S; Ramos, Romela Irene; Guo, Yi; Cheung, Ambrose L; Francis, Kevin P; Miller, Lloyd S

    2012-03-01

    Post-arthroplasty infections are a devastating problem in orthopaedic surgery. While acute infections can be treated with a single stage washout and liner exchange, chronic infections lead to multiple reoperations, prolonged antibiotic courses, extended disability, and worse clinical outcomes. Unlike previous mouse models that studied an acute infection, this work aimed to develop a model of a chronic post-arthroplasty infection. To achieve this, a stainless steel implant in the knee joints of mice was inoculated with a bioluminescent Staphylococcus aureus strain (1 × 10(2) -1 × 10(4) colony forming units, CFUs) and in vivo imaging was used to monitor the bacterial burden for 42 days. Four different S. aureus strains were compared in which the bioluminescent construct was integrated in an antibiotic selection plasmid (ALC2906), the bacterial chromosome (Xen29 and Xen40), or a stable plasmid (Xen36). ALC2906 had increased bioluminescent signals through day 10, after which the signals became undetectable. In contrast, Xen29, Xen40, and Xen36 had increased bioluminescent signals through 42 days with the highest signals observed with Xen36. ALC2906, Xen29, and Xen40 induced significantly more inflammation than Xen36 as measured by in vivo enhanced green fluorescence protein (EGFP)-neutrophil flourescence of LysEGFP mice. All four strains induced comparable biofilm formation as determined by variable-pressure scanning electron microscopy. Using a titanium implant, Xen36 had higher in vivo bioluminescence signals than Xen40 but had similar biofilm formation and adherent bacteria. In conclusion, Xen29, Xen40, and especially Xen36, which had stable bioluminescent constructs, are feasible for long-term in vivo monitoring of bacterial burden and biofilm formation to study chronic post-arthroplasty infections and potential antimicrobial interventions.

  18. Preliminary Nuclear Electric Propulsion (NEP) reliability study

    NASA Technical Reports Server (NTRS)

    Hsieh, T. M.; Nakashima, A. M.; Mondt, J. F.

    1973-01-01

    A preliminary failure mode, failure effect, and criticality analysis of the major subsystems of nuclear electric propulsion is presented. Simplified reliability block diagrams are also given. A computer program was used to calculate the reliability of the heat rejection subsystem.

  19. Tranexamic Acid Reduces Hidden Blood Loss in Patients Undergoing Total Knee Arthroplasty: A Comparative Study and Meta-Analysis

    PubMed Central

    Huang, Guang-Ping; Jia, Xu-Feng; Xiang, Zhou; Ji, Yong; Wu, Guo-Yong; Tang, Yi; Li, Jian; Zhang, Jun

    2016-01-01

    Background To explore the efficacy of tranexamic acid (TXA) on reducing hidden blood loss (HBL) in total knee arthroplasty (TKA) by conducting a comparative study and meta-analysis. Material/Methods A total of 108 patients underwent TKA was equally distributed to experimental and control groups. The only difference between two groups was the administrations of 15 mg of TXA mixed in 100 mL normal saline for experimental group and 100 mL of normal saline for control group. The volumes of blood loss, red blood loss (RBL) were recorded, calculated and analyzed. Stata 12.0 software was applied for data analysis. Results The intraoperative and postoperative blood loss volume in experimental group were remarkably reduced compared with those in control group (intraoperative: 105.1±12.1 mL vs. 185.5±20.3 mL, P<0.001; postoperative: 220.7±16.8 mL vs. 290.5±22.4 mL, P<0.001). Accordingly, the control group had significantly higher transfusion rate than experimental group (3.7% vs.25.9%, P=0.001). Our results also found that both the measured and hidden RBL were obviously reduced in experimental group compared with control group (measured RBL: 96.9±11.8 mL vs. 135.2±13.5 mL, P<0.001; hidden RBL: 170.8±37.2 mL vs. 364.2±41.5 mL, P<0.001). Furthermore, meta-analysis confirmed that TXA can notably decrease HBL (SMD=2.68, 95%CI=1.55~3.80, P<0.001). Conclusions TXA can significantly reduce the intraoperative and postoperative blood loss and HBL, therefore decreasing the transfusion need in TKA. PMID:26961597

  20. Factors for Assessing the Effectiveness of Early Rehabilitation after Minimally Invasive Total Knee Arthroplasty: A Prospective Cohort Study

    PubMed Central

    Amano, Tetsuya; Tamari, Kotaro; Tanaka, Shigeharu; Uchida, Shigehiro; Ito, Hideyuki; Morikawa, Shinya; Kawamura, Kenji

    2016-01-01

    The effectiveness of current rehabilitation programs is supported by high-level evidence from the results of randomized controlled trials, but an increasing number of patients are not discharged from the hospital because of the schedule of the critical path (CP). The present study aimed to determine which factors can be used to assess the effectiveness of early rehabilitation. We enrolled 123 patients with medial knee osteoarthritis (OA) who had undergone unilateral minimally invasive total knee arthroplasty for the first time. The following factors were assessed preoperatively: the maximum isometric muscle strength of the knee extensors and flexors, maximum knee and hip joint angle, pain, 5-m maximum walking speed, sex, age, body mass index, exercise habits, Kellgren-Lawrence grade, femorotibial angle, failure side (bilateral or unilateral knee OA), and functional independence measure. We re-evaluated physical function (i.e., muscle strength, joint angle, and pain) and motor function (5-m maximum walking speed) 14 days postoperatively. Changes in physical function, motor function (5-m maximum walking speed), and number of days to independent walking were used as explanatory variables. The postoperative duration of hospitalization (in days) was used as the dependent variable in multivariate analyses. These analyses were adjusted for sex, age, body mass index, exercise habits, Kellgren-Lawrence grade, femorotibial angle, failure side, and functional independence measure. The duration of hospitalization was significantly affected by the number of days to independent walking (p < 0.001, β = 0.507) and a change in the 5-m maximum walking speed (p = 0.016, β = -0.262). Multiple regression analysis showed that the radiographic knee grade (p = 0.029, β = 0.239) was a significant confounding factor. Independent walking and walking speed recovery were considered to reduce the duration of hospitalization. Therefore, these indices can be used to assess the effectiveness of

  1. Factors for Assessing the Effectiveness of Early Rehabilitation after Minimally Invasive Total Knee Arthroplasty: A Prospective Cohort Study.

    PubMed

    Amano, Tetsuya; Tamari, Kotaro; Tanaka, Shigeharu; Uchida, Shigehiro; Ito, Hideyuki; Morikawa, Shinya; Kawamura, Kenji

    2016-01-01

    The effectiveness of current rehabilitation programs is supported by high-level evidence from the results of randomized controlled trials, but an increasing number of patients are not discharged from the hospital because of the schedule of the critical path (CP). The present study aimed to determine which factors can be used to assess the effectiveness of early rehabilitation. We enrolled 123 patients with medial knee osteoarthritis (OA) who had undergone unilateral minimally invasive total knee arthroplasty for the first time. The following factors were assessed preoperatively: the maximum isometric muscle strength of the knee extensors and flexors, maximum knee and hip joint angle, pain, 5-m maximum walking speed, sex, age, body mass index, exercise habits, Kellgren-Lawrence grade, femorotibial angle, failure side (bilateral or unilateral knee OA), and functional independence measure. We re-evaluated physical function (i.e., muscle strength, joint angle, and pain) and motor function (5-m maximum walking speed) 14 days postoperatively. Changes in physical function, motor function (5-m maximum walking speed), and number of days to independent walking were used as explanatory variables. The postoperative duration of hospitalization (in days) was used as the dependent variable in multivariate analyses. These analyses were adjusted for sex, age, body mass index, exercise habits, Kellgren-Lawrence grade, femorotibial angle, failure side, and functional independence measure. The duration of hospitalization was significantly affected by the number of days to independent walking (p < 0.001, β = 0.507) and a change in the 5-m maximum walking speed (p = 0.016, β = -0.262). Multiple regression analysis showed that the radiographic knee grade (p = 0.029, β = 0.239) was a significant confounding factor. Independent walking and walking speed recovery were considered to reduce the duration of hospitalization. Therefore, these indices can be used to assess the effectiveness of

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

    PubMed Central

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

    2015-01-01

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

  3. Revision of failed humeral head resurfacing arthroplasty

    PubMed Central

    Streubel, Philipp N.; Simone, Juan P.; Cofield, Robert H.; Sperling, John W.

    2016-01-01

    Purpose: The purpose of this study is to assess the outcomes of a consecutive series of patients who underwent revision surgery after humeral head resurfacing (HHR). Our joint registry was queried for all patients who underwent revision arthroplasty for failed HHR at our institution from 2005 to 2010. Eleven consecutive patients (average age 54 years; range 38-69 years) that underwent revision of 11 resurfacing arthroplasties were identified. The primary indication for resurfacing had been osteoarthritis in six, glenoid dysplasia in two, a chondral lesion in two, and postinstability arthropathy in one patient. The indication for revision was pain in 10 and infection in one patient. Seven patients had undergone an average of 1.9 surgeries prior to resurfacing (range 1-3). Materials and Methods: All patients were revised to stemmed arthroplasties, including one hemiarthroplasty, two reverse, and eight anatomic total shoulder arthroplasties at a mean 33 months after primary resurfacing (range 10-131 months). A deltopectoral approach was used in seven patients; four patients required an anteromedial approach due to severe scarring. Subscapularis attenuation was found in four cases, two of which required reverse total shoulder arthroplasty. Bone grafting was required in one glenoid and three humeri. Results: At a mean follow-up of 3.5 years (range 1.6-6.9 years), modified Neer score was rated as satisfactory in five patients and unsatisfactory in six. Abduction and external rotation improved from 73° to 88° (P = 0.32) and from 23° to 32° (P = 0.28) respectively. Reoperation was required in two patients, including one hematoma and one revision for instability. Conclusion: Outcomes of revision of HHR arthroplasty in this cohort did not improve upon those reported for revision of stemmed humeral implants. A comparative study would be required to allow for definitive conclusions to be made. PMID:26980986

  4. Preliminary design study for an atomospheric science facility

    NASA Technical Reports Server (NTRS)

    Hutchison, R.

    1972-01-01

    The activities and results of the Atmospheric Science Facility preliminary design study are reported. The objectives of the study were to define the scientific goals, to determine the range of experiment types, and to develop the preliminary instrument design requirements for a reusable, general purpose, optical research facility for investigating the earth's atmosphere from a space shuttle orbital vehicle.

  5. Bipolar hip arthroplasty.

    PubMed

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

    2011-12-01

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

  6. Prospective, Randomized, Multicenter FDA IDE Study of CHARITÉ Artificial Disc versus Lumbar Fusion: Effect at 5-year Follow-up of Prior Surgery and Prior Discectomy on Clinical Outcomes Following Lumbar Arthroplasty

    PubMed Central

    McAfee, Paul C.; Banco, Robert J.; Blumenthal, Scott L.; Guyer, Richard D.; Holt, Richard T.; Majd, Mohamed E.

    2009-01-01

    Background Candidates for spinal arthrodesis or arthroplasty often present with a history of prior surgery such as laminectomy, laminotomy or discectomy. In this study, lumbar arthroplasty patients with prior surgery, and in particular patients with prior discectomy, were evaluated for their clinical outcomes at the 5-year time point. Methods Randomized patients from the 5-year CHARITÉ investigational device exemption (IDE) study were divided as follows: 1) fusion prior surgery (excluding prior decompression with fusion) group (FSG); 2) fusion prior discectomy group (FDG); 3) fusion no prior surgery group (FNG); 4) arthroplasty prior surgery group (ASG); 5) arthroplasty prior discectomy group (ADG); and 6) arthroplasty no prior surgery group (ANG). The 5-year clinical outcomes included visual analog scale (VAS), Oswestry Disability Index 2.0 (ODI), patient satisfaction, and work status. Results In the arthroplasty group, all subgroups had statistically significant VAS improvements from baseline (VAS change from baseline: ASG = -36.6 ± 29.6, P < 0.0001; ADG = -40.2 ± 30.9, P = 0.0002; ANG = -36.5 ± 34.6, P < 0.0001). There was no statistical difference between subgroups (P = 0.5587). In the fusion group, VAS changes from baseline were statistically significant for the FNG and FSG subgroups, but not for the FDG patients (FNG = -46.3 ± 28.8, P < 0.0001; FSG = -24.2 ± 36.4, P = 0.0444; FDG = -26.7 ± 38.7, P = 0.2188). A trend of decreased VAS improvements was observed for FSG versus FNG (P = 0.0703) subgroups. Similar findings and trends were observed in ODI scores (Changes in ODI from baseline: ASG = -20.4 ± 23.8, P < 0.0001; ANG = -26.6±21.1, P < 0.0001; ADG= -17.6 ± 28.6, P = 0.0116; FSG = -14.5 ± 21.2, P = 0.0303; FNG= -32.5 ± 22.6, P < 0.0001; FDG = -10.7 ± 9.4, P = 0.0938). The greatest improvement in work status from preoperative to postoperative was seen in the ADG subgroup (28% increase in part- and full-time employment), while the FDG subgroup

  7. Primary stability of inferior tilt fixation of the glenoid component in reverse total shoulder arthroplasty: A finite element study.

    PubMed

    Chae, Soo-Won; Lee, Haea; Kim, Soo Min; Lee, Juneyoung; Han, Seung-Ho; Kim, Soung-Yon

    2016-06-01

    Glenoid component fixation with inferior tilt has been suggested as one of the surgical methods to decrease scapular notching and improve stability, but its clinically beneficial effect remains a concern. We evaluated the influence of inferior tilt fixation of the glenoid component on primary stability in reverse total shoulder arthroplasty by finite element analysis. Finite element models were constructed from cadaveric scapulae of females over the age of 60 years and glenoid components from reverse total shoulder arthroplasty. The relative micromotion at the bone-glenoid component interface, distribution of bone stress under the glenoid component and around the screws, contact area between the bone and screws, and cut surface area of the cancellous bone exposed after glenoid reaming were analyzed and compared between a neutral and 10° inferior tilt fixation of the glenoid component. The 10° inferior tilt fixation demonstrated greater relative micromotion and higher bone stress than the neutral tilt fixation. Eccentric reaming, which is done to produce the inferior tilt fixation of the glenoid component, increased glenoid cancellous bone exposure and decreased bone-screws contact area. Inferior tilt fixation of the glenoid component may adversely affect primary stability and longevity after reverse total shoulder arthroplasty. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1061-1068, 2016.

  8. Biomechanical benefits of anterior offsetting of humeral head component in posteriorly unstable total shoulder arthroplasty: A cadaveric study.

    PubMed

    Kim, Hyun-Min Mike; Chacon, Alexander C; Andrews, Seth H; Roush, Evan P; Cho, Edward; Conaway, William K; Kunselman, Allen R; Lewis, Gregory S

    2016-04-01

    Restoration of joint stability during total shoulder arthroplasty can be challenging in the face of severe glenoid retroversion. A novel technique of humeral head component anterior-offsetting has been proposed to address posterior instability. We evaluated the biomechanical benefits of this technique in cadaveric specimens. Total shoulder arthroplasty was performed in 14 cadaveric shoulders from 7 donors. Complementary shoulders were assigned to either 10° or 20° glenoid retroversion, with retroversion created by eccentric reaming. Two humeral head component offset positions were tested in each specimen: The anatomic (posterior) and anterior (reverse). With loads applied to the rotator cuff and deltoid, joint contact pressures and the force and energy required for posterior humeral head translation were measured. The force and energy required to displace the humeral head posteriorly increased significantly with the anterior offset position compared to the anatomic offset position. The joint contact pressures were significantly shifted anteriorly, and the joint contact area significantly increased with the anterior offset position. Anterior offsetting of the humeral head component increased the resistance to posterior humeral head translation, shifted joint contact pressures anteriorly, and increased joint contact area, thus, potentially increasing the joint stability in total shoulder arthroplasty with simulated glenoid retroversion. PMID:26356804

  9. Effect of size and dimensional tolerance of reverse total shoulder arthroplasty on wear: An in-silico study.

    PubMed

    Mattei, Lorenza; Di Puccio, Francesca; Joyce, Thomas J; Ciulli, Enrico

    2016-08-01

    Although huge research efforts have been devoted to wear analysis of ultra-high molecular weight polyethylene (UHMWPE) in hip and knee implants, shoulder prostheses have been studied only marginally. Recently, the authors presented a numerical wear model of reverse total shoulder arthroplasties (RTSAs), and its application for estimating the wear coefficient k from experimental data according to different wear laws. In this study, such model and k expressions are exploited to investigate the sensitivity of UHMWPE wear to implant size and dimensional tolerance. A set of 10 different geometries was analysed, considering nominal diameters in the range 36-42mm, available on the market, and a cup dimensional tolerance of +0.2, -0.0mm (resulting in a diametrical clearance ranging between 0.04-0.24mm), estimated from measurements on RTSAs. Since the most reliable wear law and wear coefficient k for UHMWPE are still controversial in the literature, both the Archard law (AR) and the wear law of UHMWPE (PE), as well as four different k expressions were considered, carrying out a total of 40 simulations. Results showed that the wear volume increases with the implant size and decreases with the dimensional tolerance for both the wear laws. Interestingly, different trends were obtained for the maximum wear depth vs. clearance: the best performing implants should have a high conformity according to the AR law but low conformity for the PE law. However, according to both laws, wear is highly affected by both implant size and dimensional tolerance, although it is much more sensitive to the latter, with up to a twofold variation of wear predicted. Indeed, dimensional tolerance directly alters the clearance, and therefore the lubrication and contact pressure distribution in the implant. Rather surprisingly the role of dimensional tolerance has been completely disregarded in the literature, as well as in the standards. Furthermore, this study notes some important issues for future

  10. Effect of size and dimensional tolerance of reverse total shoulder arthroplasty on wear: An in-silico study.

    PubMed

    Mattei, Lorenza; Di Puccio, Francesca; Joyce, Thomas J; Ciulli, Enrico

    2016-08-01

    Although huge research efforts have been devoted to wear analysis of ultra-high molecular weight polyethylene (UHMWPE) in hip and knee implants, shoulder prostheses have been studied only marginally. Recently, the authors presented a numerical wear model of reverse total shoulder arthroplasties (RTSAs), and its application for estimating the wear coefficient k from experimental data according to different wear laws. In this study, such model and k expressions are exploited to investigate the sensitivity of UHMWPE wear to implant size and dimensional tolerance. A set of 10 different geometries was analysed, considering nominal diameters in the range 36-42mm, available on the market, and a cup dimensional tolerance of +0.2, -0.0mm (resulting in a diametrical clearance ranging between 0.04-0.24mm), estimated from measurements on RTSAs. Since the most reliable wear law and wear coefficient k for UHMWPE are still controversial in the literature, both the Archard law (AR) and the wear law of UHMWPE (PE), as well as four different k expressions were considered, carrying out a total of 40 simulations. Results showed that the wear volume increases with the implant size and decreases with the dimensional tolerance for both the wear laws. Interestingly, different trends were obtained for the maximum wear depth vs. clearance: the best performing implants should have a high conformity according to the AR law but low conformity for the PE law. However, according to both laws, wear is highly affected by both implant size and dimensional tolerance, although it is much more sensitive to the latter, with up to a twofold variation of wear predicted. Indeed, dimensional tolerance directly alters the clearance, and therefore the lubrication and contact pressure distribution in the implant. Rather surprisingly the role of dimensional tolerance has been completely disregarded in the literature, as well as in the standards. Furthermore, this study notes some important issues for future

  11. Frequent Dental Scaling Is Associated with a Reduced Risk of Periprosthetic Infection following Total Knee Arthroplasty: A Nationwide Population-Based Nested Case-Control Study

    PubMed Central

    Tai, Ta-Wei; Lin, Tzu-Chieh; Ho, Chia-Jung; Kao Yang, Yea-Huei; Yang, Chyun-Yu

    2016-01-01

    Oral bacteremia has been presumed to be an important risk factor for total knee arthroplasty (TKA) infection. We aimed to investigate whether dental scaling could reduce the risk of TKA infection. A nested case-control study was conducted to compare 1,291 TKA patients who underwent resection arthroplasty for infected TKA and 5,004 matched controls without infection in the TKA cohort of Taiwan’s National Health Insurance Research Database (NHIRD). The frequency of dental scaling was analyzed. Multiple conditional logistic regression was used to assess the frequency of dental scaling and the risk of TKA infection. The percentage of patients who received dental scaling was higher in the control group than in the TKA infection group. The risk for TKA infection was 20% lower for patients who received dental scaling at least once within a 3-year period than for patients who never received dental scaling. Moreover, the risk of TKA infection was reduced by 31% among patients who underwent more frequent dental scaling (5–6 times within 3 years). Frequent and regular dental scaling is associated with a reduced risk of TKA infection. PMID:27336912

  12. Frequent Dental Scaling Is Associated with a Reduced Risk of Periprosthetic Infection following Total Knee Arthroplasty: A Nationwide Population-Based Nested Case-Control Study.

    PubMed

    Tai, Ta-Wei; Lin, Tzu-Chieh; Ho, Chia-Jung; Kao Yang, Yea-Huei; Yang, Chyun-Yu

    2016-01-01

    Oral bacteremia has been presumed to be an important risk factor for total knee arthroplasty (TKA) infection. We aimed to investigate whether dental scaling could reduce the risk of TKA infection. A nested case-control study was conducted to compare 1,291 TKA patients who underwent resection arthroplasty for infected TKA and 5,004 matched controls without infection in the TKA cohort of Taiwan's National Health Insurance Research Database (NHIRD). The frequency of dental scaling was analyzed. Multiple conditional logistic regression was used to assess the frequency of dental scaling and the risk of TKA infection. The percentage of patients who received dental scaling was higher in the control group than in the TKA infection group. The risk for TKA infection was 20% lower for patients who received dental scaling at least once within a 3-year period than for patients who never received dental scaling. Moreover, the risk of TKA infection was reduced by 31% among patients who underwent more frequent dental scaling (5-6 times within 3 years). Frequent and regular dental scaling is associated with a reduced risk of TKA infection. PMID:27336912

  13. [Development, terminology, principles, and controversies in minimally invasive knee arthroplasty].

    PubMed

    Hofmann, S; Pietsch, M

    2007-12-01

    Minimally invasive total knee arthroplasty is a logical and further improvement of the good results achieved with minimally invasive unicondylar knee arthroplasty. The terminology for minimally invasive surgery (MIS) is confusing and comparison of different techniques is therefore difficult. A simple separation between less invasive and minimally invasive techniques will be presented. Besides the approach, minimally invasive surgical principles are very important. MIS in total knee arthroplasty is discussed very controversially at the moment. The preliminary results of these new techniques are very promising. Up to now there is much more feeling then knowing. Important questions (risk-benefit analysis, which technique for which patient and surgeon, education and cost-effectiveness) must be addressed by the proponents of this MIS technique. Step by step learning of these new techniques (evolution instead of revolution) in specific education centres is strongly recommended. Ultimately, patients and surgeons will have to decide whether these new techniques will only be a modern trend or represent the future.

  14. Infection after primary hip arthroplasty

    PubMed Central

    2011-01-01

    Background and purpose The aim of the present study was to assess incidence of and risk factors for infection after hip arthroplasty in data from 3 national health registries. We investigated differences in risk patterns between surgical site infection (SSI) and revision due to infection after primary total hip arthroplasty (THA) and hemiarthroplasty (HA). Materials and methods This observational study was based on prospective data from 2005–2009 on primary THAs and HAs from the Norwegian Arthroplasty Register (NAR), the Norwegian Hip Fracture Register (NHFR), and the Norwegian Surveillance System for Healthcare–Associated Infections (NOIS). The Norwegian Patient Register (NPR) was used for evaluation of case reporting. Cox regression analyses were performed with revision due to infection as endpoint for data from the NAR and the NHFR, and with SSI as the endpoint for data from the NOIS. Results The 1–year incidence of SSI in the NOIS was 3.0% after THA (167/5,540) and 7.3% after HA (103/1,416). The 1–year incidence of revision due to infection was 0.7% for THAs in the NAR (182/24,512) and 1.5% for HAs in the NHFR (128/8,262). Risk factors for SSI after THA were advanced age, ASA class higher than 2, and short duration of surgery. For THA, the risk factors for revision due to infection were male sex, advanced age, ASA class higher than 1, emergency surgery, uncemented fixation, and a National Nosocomial Infection Surveillance (NNIS) risk index of 2 or more. For HAs inserted after fracture, age less than 60 and short duration of surgery were risk factors of revision due to infection. Interpretation The incidences of SSI and revision due to infection after primary hip replacements in Norway are similar to those in other countries. There may be differences in risk pattern between SSI and revision due to infection after arthroplasty. The risk patterns for revision due to infection appear to be different for HA and THA. PMID:22066562

  15. Implant based differences in adverse local tissue reaction in failed total hip arthroplasties: a morphological and immunohistochemical study

    PubMed Central

    2014-01-01

    Background Adverse local tissue reaction (ALTR) is characterized by periprosthetic soft tissue inflammation composed of a mixed inflammatory cell infiltrate, extensive soft tissue necrosis, and vascular changes. Multiple hip implant classes have been reported to result in ALTR, and clinical differences may represent variation in the soft tissue response at the cellular and tissue levels. The purpose of this study was to describe similarities and differences in periprosthetic tissue structure, organization, and cellular composition by conventional histology and immunohistochemistry in ALTR resulting from two common total hip arthroplasty (THA) implant classes. Methods Consecutive patients presenting with ALTR from two major hip implant classes (N = 54 patients with Dual-Modular Neck implant; N = 14 patients with Metal-on-Metal implant) were identified from our prospective Osteolysis Tissue Database and Repository. Clinical characteristics including age, sex, BMI, length of implantation, and serum metal ion levels were recorded. Retrieved synovial tissue morphology was graded using light microscopy and cellular composition was assessed using immunohistochemistry. Results Length of implantation was shorter in the DMN group versus MoM THA group (21.3 [8.4] months versus 43.6 [13.8] months respectively; p < 0.005) suggesting differences in implant performance. Morphologic examination revealed a common spectrum of neo-synovial proliferation and necrosis in both groups. Macrophages were more commonly present in diffuse sheets (Grade 3) in the MoM relative to DMN group (p = 0.016). Perivascular lymphocytes with germinal centers (Grade 4) were more common in the DMN group, which trended towards significance (p = 0.066). Qualitative differences in corrosion product morphology were seen between the two groups. Immunohistochemistry showed features of a CD4 and GATA-3 rich lymphocyte reaction in both implants, with increased ratios of perivascular T

  16. 33. Historic American Buildings Survey COPY OF PRELIMINARY STUDY FOR ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    33. Historic American Buildings Survey COPY OF PRELIMINARY STUDY FOR HEALY BUILDING, c. 1876 (COURTESY OF THE COMMISSION OF FINE ARTS) - Georgetown University, Healy Building, Thirty-seventh & O Streets, Northwest, Washington, District of Columbia, DC

  17. Positive Culture Rate in Revision Shoulder Arthroplasty

    PubMed Central

    Hobgood, E. Rhett

    2009-01-01

    We recognized a trend of positive cultures taken from presumably uninfected shoulders during revision arthroplasty. Owing to the indolent nature of common shoulder pathogens such as Propionibacterium acnes, these cultures often become positive several days, even weeks, after surgery. Having concern regarding the potential importance of these positive cultures, we reviewed our revision arthroplasty population to determine the rate of positive intraoperative cultures in patients presumed to be aseptic, to characterize the isolated organisms, and to determine the subsequent development of infection. We retrospectively reviewed 27 patients (28 revisions) presumed to be uninfected between April 2005 and October 2007. Intraoperative cultures were positive in eight (29%) of the 28 revisions. Propionibacterium acnes was isolated in six. Methicillin-resistant Staphylococcus aureus was isolated in one patient and coagulase-negative Staphylococcus aureus was isolated in one patient. One-year followup was available on 24 of the 28 revisions. Two of the eight culture-positive revisions had a subsequent infection develop. Cultures taken at revision surgery for failed shoulder arthroplasty are often positive, and our findings document the importance of these positive cultures. Our data confirm previous reports isolating Propionibacterium acnes as a primary pathogen in revision shoulder arthroplasty. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:19434469

  18. Rural vs. urban utilization of total joint arthroplasty.

    PubMed

    Banerjee, Devraj; Illingworth, Kenneth David; Novicoff, Wendy M; Scaife, Steven L; Jones, Braden K; Saleh, Khaled J

    2013-06-01

    The purpose of this study was to analyze the association between patient demographics and hospital demographics on utilization of total joint arthroplasty in rural and urban populations from the National Inpatient Sample database. Any patient that was discharged after a primary total hip or primary total knee arthroplasty was included in this study. Results showed that rural patients living in a Northeastern hospital region compared to West, less than 65 years of age, females, Blacks and Hispanics were less likely to undergo total joint arthroplasty compared to their urban counterparts. Rural patient were more likely to undergo total joint arthroplasty compared to their urban counterparts if they were in the Midwest and had Medicare as their primary payer provider.

  19. The impact of peripheral nerve blocks on perioperative outcome in hip and knee arthroplasty-a population-based study.

    PubMed

    Memtsoudis, Stavros G; Poeran, Jashvant; Cozowicz, Crispiana; Zubizarreta, Nicole; Ozbek, Umut; Mazumdar, Madhu

    2016-10-01

    The role of anesthesia techniques on perioperative outcomes on a population level has recently gained widespread interest. Although mainly neuraxial vs general anesthesia has been addressed, population-level data on the impact of peripheral nerve blocks (PNBs) are still lacking. Therefore, we investigated the association between PNB use and outcomes using retrospective data on 1,062,152 recipients of hip and knee arthroplasties (total hip arthroplasty [THA]/total knee arthroplasty [TKA]) from the national Premier Perspective database (2006-2013). Multilevel multivariable logistic regression models measured associations between PNB use and outcomes. Complications included cardiac, pulmonary, gastrointestinal and renal complications, cerebrovascular events, infections, wound complications, thromboembolic complications, inpatient falls, and mortality. Resource utilization variables included blood transfusions, intensive care unit admissions, opioid consumption, cost, and length of stay. Overall, 12.5% of patients received a PNB, with an increase over time particularly among TKAs. Peripheral nerve block use was associated with lower odds for most adverse outcomes mainly among patients with THA. Notable beneficial effects were seen for wound complications (odds ratio 0.60 [95% confidence interval, 0.49-0.74]) among THA recipients and pulmonary complications (odds ratio 0.83 [95% confidence interval, 0.72-0.94]) in patients with TKA. Peripheral nerve block use was significantly (P < 0.0001) associated with a -16.2% and -12.7% reduction in opioid consumption for patients with THA and TKA, respectively. In conclusion, our results indicate that PNBs might be associated with superior perioperative population-level outcomes. In light of the inability to establish a causal relationship and the presence of residual confounding, we strongly advocate for further prospective investigation, ideally in multicenter, randomized trials, to establish the potential impact of PNBs on

  20. Cost of post-operative intravenous iron therapy in total lower limb arthroplasty: a retrospective, matched cohort study

    PubMed Central

    Muñoz, Manuel; Gómez-Ramírez, Susana; Martín-Montañez, Elisa; Naveira, Enrique; Seara, Javier; Pavía, José

    2014-01-01

    Background Requirements for allogeneic red cell transfusion after total lower limb arthroplasty are still high (20–50%), and post-operative intravenous iron has been shown to reduce transfusion requirements for this surgery. We performed a cost analysis to ascertain whether this alternative is also likely to be cost-effective. Materials and methods Data from 182 matched-pairs of total lower limb arthroplasty patients, managed with a restrictive transfusion protocol and without (control group) or with post-operative intravenous iron (iron group), were retrospectively reviewed. Acquisition and administration costs of iron (iron sucrose or ferric carboxymaltose) and allogeneic red cell concentrates, haemoglobin measurements, and prolonged stay in hospital were used for blood management cost analysis. Results Patients in the iron group received 600 mg intravenous iron, without clinically relevant incidents, and had a lower allogeneic transfusion rate (11.5% vs 26.4% for the iron and control groups, respectively; p=0.001). The reduction in transfusion rate was more pronounced in anaemic patients (17% vs 40%; p=0.015) than in non-anaemic ones (9.6% vs 21.2%; p=0.011). There were no differences with respect to post-operative infection rate. Patients receiving allogeneic transfusion stayed in hospital longer (+1.9 days [95% CI: 1.2–2.6]). As intravenous iron reduces the allogeneic transfusion rate, both iron formulations were cost-neutral in the different cost scenarios (−25.5 to 62.1 €/patient for iron sucrose, and −51.1 to 64.4 €/patient for ferric carboxymaltose). Discussion In patients presenting with or without pre-operative anaemia, post-operative intravenous iron after total lower limb arthroplasty seems to be safe and is associated with reduced transfusion rates, without incremental costs. For anaemic patients, its efficacy could be increased by associating some other blood-saving method. PMID:24120595

  1. Dislocation after total knee arthroplasty.

    PubMed

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

    2007-05-01

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

  2. Knee arthroplasty in Denmark, Norway and Sweden

    PubMed Central

    Bizjajeva, Svetlana; Fenstad, Anne Marie; Furnes, Ove; Lidgren, Lars; Mehnert, Frank; Odgaard, Anders; Pedersen, Alma Becic; Havelin, Leif Ivar

    2010-01-01

    Background and purpose The number of national arthroplasty registries is increasing. However, the methods of registration, classification, and analysis often differ. Methods We combined data from 3 Nordic knee arthroplasty registers, comparing demographics, methods, and overall results. Primary arthroplasties during the period 1997–2007 were included. Each register produced a dataset of predefined variables, after which the data were combined and descriptive and survival statistics produced. Results The incidence of knee arthroplasty increased in all 3 countries, but most in Denmark. Norway had the lowest number of procedures per hospital—less than half that of Sweden and Denmark. The preference for implant brands varied and only 3 total brands and 1 unicompartmental brand were common in all 3 countries. Use of patellar button for total knee arthroplasty was popular in Denmark (76%) but not in Norway (11%) or Sweden (14%). Uncemented or hybrid fixation of components was also more frequent in Denmark (22%) than in Norway (14%) and Sweden (2%). After total knee arthroplasty for osteoarthritis, the cumulative revision rate (CRR) was lowest in Sweden, with Denmark and Norway having a relative risk (RR) of 1.4 (95% CI: 1.3–1.6) and 1.6 (CI: 1.4–1.7) times higher. The result was similar when only including brands used in more than 200 cases in all 3 countries (AGC, Duracon, and NexGen). After unicompartmental arthroplasty for osteoarthritis, the CRR for all models was also lowest in Sweden, with Denmark and Norway having RRs of 1.7 (CI: 1.4–2.0) and 1.5 (CI: 1.3–1.8), respectively. When only the Oxford implant was analyzed, however, the CRRs were similar and the RRs were 1.2 (CI: 0.9–1.7) and 1.3 (CI: 1.0–1.7). Interpretation We found considerable differences between the 3 countries, with Sweden having a lower revision rate than Denmark and Norway. Further classification and standardization work is needed to permit more elaborate studies. PMID:20180723

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

    PubMed Central

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

    2015-01-01

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

  4. Revision hip arthroplasty using impacted cancellous bone and cement: a long-term follow-up study.

    PubMed

    Arumugam, Gowthaman; Nanjayan, Shashi Kumar; Quah, Conal; Wraighte, Philip; Howard, Peter

    2015-12-01

    Acetabular bone deficiency is one of the many challenging problems encountered in revision hip arthroplasty. A variety of surgical options and techniques are available including impaction bone grafting. We present our long-term experience of 68 consecutive cups in 64 patients, using impacted cancellous bone grafting with bone cement. With a mean follow-up of 10.5 year (IQR 7.5-12.9) after revision surgery, three implants had undergone further revision. Three patients had subsequent femoral peri-prosthetic fractures, and none of these three required further acetabular revision. Survival of the acetabular components was 95.5 % for all causes and 100 % for aseptic loosening as the end point, with a further four patients showing radiographic, but asymptomatic loosening. A significant correlation was found between previous revision and re-revision (early failure) (p = 0.01) as well as progression of lytic lesion and re-revision (p = 0.01). The median Harris hip score at final follow-up was 79.5 (IQR 67.9-80.4). The use of impacted morcellised allograft bone with a cemented cup is an effective technique to achieve longevity and restoration of bone stock in acetabular revision arthroplasty. Our series has shown good clinical and radiological outcome with survivorship of the prosthesis exceeding 95 % at 10 years.

  5. Preliminary design studies of an advanced general aviation aircraft

    NASA Technical Reports Server (NTRS)

    1991-01-01

    Preliminary design studies are presented for an advanced general aviation aircraft. Advanced guidance and display concepts, laminar flow, smart structures, fuselage and wing structural design and manufacturing, and preliminary configuration design are discussed. This project was conducted as a graduate level design class under the auspices of the KU/NASA/USRA Advanced Design Program in Aeronautics. The results obtained during the fall semester of 1990 (Phase 1) and the spring semester of 1991 (Phase 2) are presented.

  6. Measurement of pelvic osteolytic lesions in follow-up studies after total hip arthroplasty

    NASA Astrophysics Data System (ADS)

    Castaneda, Benjamin; Tamez-Pena, Jose G.; Totterman, Saara; O'Keefe, Regis; Looney, R. John

    2006-03-01

    Previous studies have demonstrated the plausibility of using volumetric computerized tomography to provide an accurate representation and measurement of volume for pelvic osteolytic lesions following total hip joint replacement. These studies have been performed manually (or computed-assisted) by expert radiologists with the disadvantage of poor reproducibility of the experiment. The purpose of this work is to minimize the effect of user interaction in these experiments by introducing Laplacian level set methods in the volume segmentation process and using temporal articulated registration in order to follow the evolution of a lesion over time. Laplacian level set methods reduce the inter and intra-observer variability by attaching the segmented contour to edges defined in the image while keeping smoothness. The registration process allows the information of the lesion from the first visit to be used in the segmentation process of the current visit. This work compares the automated results on 7 volunteers versus the volume measured manually. Results have shown that the proposed technique is able to track osteolytic lesions and detect changes in volume over time. Intra-reader and inter-observer variabilities were reduced.

  7. Mosaic arthroplasty of the medial femoral condyle in horses - An experimental study.

    PubMed

    Bodó, Gábor; Vásárhelyi, Gábor; Hangody, László; Módis, László

    2014-06-01

    One Arabian and 5 Hungarian half-bred horses were used to study the macroscopic and microscopic survival of autologous osteochondral grafts in the weight-bearing surface of the medial femoral condyle (MFC). Grafts were harvested from the cranial surface of the medial femoral trochlea (MFT) under arthroscopic control. Three of them were transplanted into the weight-bearing surface of the contralateral MFC using an arthrotomy approach. Three months later this transplantation procedure was repeated on the opposite stifle joints in the same animals, but at that time transplantation was performed arthroscopically. Follow-up arthroscopy was carried out 12 months after the first operations, and biopsies were taken from both the recipient and the donor sites for histological examination. During follow-up arthroscopy, the transplanted areas looked congruent and smooth. Microscopically, the characteristics of hyaline cartilage were present in 5 out of the 10 biopsies examined; however, in the other half of biopsies glycosaminoglycan (GAG) loss and change in the architecture of the transplanted cartilage was observed. In a 16-year-old horse, all grafts broke during harvesting, and thus transplantation was not performed. No radiological signs of osteoarthritic changes were detected 9 to 12 months after the operations in the donor and recipient joints. Clinically, no lameness or effusion was present three months after the transplantations.

  8. Mosaic arthroplasty of the medial femoral condyle in horses - An experimental study.

    PubMed

    Bodó, Gábor; Vásárhelyi, Gábor; Hangody, László; Módis, László

    2014-06-01

    One Arabian and 5 Hungarian half-bred horses were used to study the macroscopic and microscopic survival of autologous osteochondral grafts in the weight-bearing surface of the medial femoral condyle (MFC). Grafts were harvested from the cranial surface of the medial femoral trochlea (MFT) under arthroscopic control. Three of them were transplanted into the weight-bearing surface of the contralateral MFC using an arthrotomy approach. Three months later this transplantation procedure was repeated on the opposite stifle joints in the same animals, but at that time transplantation was performed arthroscopically. Follow-up arthroscopy was carried out 12 months after the first operations, and biopsies were taken from both the recipient and the donor sites for histological examination. During follow-up arthroscopy, the transplanted areas looked congruent and smooth. Microscopically, the characteristics of hyaline cartilage were present in 5 out of the 10 biopsies examined; however, in the other half of biopsies glycosaminoglycan (GAG) loss and change in the architecture of the transplanted cartilage was observed. In a 16-year-old horse, all grafts broke during harvesting, and thus transplantation was not performed. No radiological signs of osteoarthritic changes were detected 9 to 12 months after the operations in the donor and recipient joints. Clinically, no lameness or effusion was present three months after the transplantations. PMID:24334083

  9. Preliminary design study. Shuttle modular scanning spectroradiometer

    NASA Technical Reports Server (NTRS)

    1975-01-01

    Fundamental concepts on which to base a detailed design for a Shuttle Modular Scanning Spectroradiometer were developed, and a preliminary design is presented. The recommended design features modularity and flexibility. It includes a 75-cm f/1.7-telescope assembly in an all-reflective Schmidt configuration, a solid state scan system (pushbroom) with high resolution over a 15 deg field of view, and ten detector channels covering the spectral range from 0.45 to 12.5 micrometers. It uses charge transfer device techniques to accommodate a large number of detector elements for earth observation measurements. Methods for in-flight radiometric calibration, for image motion compensation, and for data processing are described. Recommendations for ground support equipment are included, and interfaces with the shuttle orbiter vehicle are illustrated.

  10. Total Hip Arthroplasty for Failed Internal Fixation After Femoral Neck Fracture Versus That for Acute Displaced Femoral Neck Fracture: A Comparative Study.

    PubMed

    Yang, Zhouyuan; Liu, Huifang; Xie, Xiaowei; Tan, Zhen; Qin, Tianqiang; Kang, Pengde

    2015-08-01

    The outcome of total hip arthroplasty (THA) for failed internal fixation after femoral neck fracture (FNF) versus that for acute displaced femoral neck fracture is still controversial. This study retrospectively analyzed a consecutive series of 130 THAs for acute displaced FNF (64, group I) and for failed internal fixation (66, group II). Results showed THAs in group II were more technically demanding procedures with longer operative time and larger amounts of drainage compared to that in group I. Furthermore, multivariate analysis revealed that the associations between THAs (group II) and hip complications were notable (OR=4.15, P=0.017). These increased risks should be paid much attention to, not only for choosing the appropriate treatment option, but also for providing effective perioperative care.

  11. Limited femoral navigation versus conventional intramedullary femoral jig based instrumentation for achieving optimal restoration of mechanical axis post total knee arthroplasty: a prospective comparative study of 200 knees.

    PubMed

    Shah, Nilen A; Patil, Hitendra G; Dhawale, Amol S; Khedkar, Bipin M

    2015-04-01

    A prospective comparative study was conducted to compare the mechanical axis post total knee arthroplasty (TKA) between two groups: In the first group of 100 knees (ASM group) Articular Surface Mounted navigation system was used to guide the distal femoral cut. In the second group of 100 knees (JIG group) conventional intramedullary femoral jig was used. The postoperative mechanical axis of the leg was within 3° of neutral alignment in 90% of the TKA in the ASM group (mean 178.12°) as compared to 74% in the JIG group (mean 177.02°). This difference was statistically significant (P<0.05). The data presented show that the use of limited femoral navigation leads to more accurate restoration of mechanical axis alignment when compared to conventional intramedullary femoral jigs.

  12. Does Robotic-Assisted Computer Navigation Affect Acetabular Cup Positioning in Total Hip Arthroplasty in the Obese Patient? A Comparison Study.

    PubMed

    Gupta, Asheesh; Redmond, John M; Hammarstedt, Jon E; Petrakos, Alexandra E; Vemula, S Pavan; Domb, Benjamin G

    2015-12-01

    Obese populations present challenges for acetabular cup placement during total hip arthroplasty (THA). This study examines the accuracy of acetabular cup inclination and version in the obese patient with robotic-assisted computer navigation. A total of 105 patients underwent robotic-assisted computer navigation THA with a posterior approach. Groups were divided on body mass index (BMI, kg/m(2)) of <30, 30-35, and >35. There was no statistical difference between the BMI <30 (n=59), BMI 30-35 (n=34) and BMI >35 (n=12) groups for acetabular inclination (P=0.43) or version (P=0.95). Robotic-assisted computer navigation provided accurate and reproducible placement of the acetabular cup within safe zones for inclination and version in the obese patient.

  13. Risk factors for persistent and new chronic opioid use in patients undergoing total hip arthroplasty: a retrospective cohort study

    PubMed Central

    Inacio, Maria C S; Hansen, Craig; Pratt, Nicole L; Graves, Stephen E; Roughead, Elizabeth E

    2016-01-01

    Objectives To determine chronic opioid use pre-THA (total hip arthroplasty) and post-THA, and risk factors for persistent or new chronic opioid use post-THA. Design Retrospective cohort study. Setting Australian Government Department of Veterans' Affairs health claims database. Participants 9525 patients who had an elective unilateral THA between 1/01/2001 and 12/31/2012. Primary outcome measure Chronic opioid use. Defined as 90 days of continuous opioid use or 120 days of non-continuous use. Results Pre-THA, 6.2% (n=593) of patients were chronic users, while 5.2% (n=492) were post-THA. Among the 492 postoperative chronic users, 302 (61%) were chronic users pre-THA and post-THA and 190 (39%) became new chronic users after surgery. Risk factors for persistent chronic use were younger age (OR=0.96, 95% CI 0.93 to 0.99/1-year increment), back pain (OR=1.99, 95% CI 1.20 to 3.23), diabetes (OR=3.52, 95% CI 1.05 to 11.8), hypnotics use (OR=2.52, 95% CI 1.48 to 4.30) and higher pre-THA opioid exposure (compared with opioid use for 94–157 days, 157–224 days (OR=3.75, 95% CI 2.28 to 6.18), 225+ days (OR=5.18, 95% CI 2.92 to 9.19). Risk factors for new chronic opioid use post-THA were being a woman (OR=1.40, 95% CI 1.00 to 1.96), back pain (OR=3.90, 95% CI 2.85 to 5.33), depression (OR=1.70, 95% CI 1.20 to 2.41), gastric acid disease (OR=1.62, 95% CI 1.16 to 2.25), migraine (OR=5.11, 95% CI 1.08 to 24.18), liver disease (OR=4.33, 95% CI 1.08 to 17.35), weight loss (OR=2.60, 95% CI 1.06 to 6.39), dementia (OR=2.19, 95% CI 1.04 to 4.61), hyperlipidaemia (OR=1.38, 95% CI 1.00 to 1.91), hypnotics (OR=1.56, 95% CI 1.13 to 2.16) and antineuropathic pain medication use (OR=3.11, 95% CI 2.05 to 4.72). Conclusions Patients undergoing THA are exposed to opioids for long periods of time, putting them at high risk of harm related to opioid use. We identified groups at risk of chronic opioid use, including younger patients and women, as well as modifiable risk factors of

  14. Femoral Component Survival in Hybrid Total Knee Arthroplasty.

    PubMed

    Perry, Clayton R; Perry, Kevin I

    2016-05-01

    Although the majority of North American surgeons perform total knee arthroplasty by cementing both the femoral and the tibial components, hybrid fixation with a press-fit femur and cemented tibia is an alternative form of total knee arthroplasty performed by some. Currently, there is a paucity of literature evaluating long-term outcomes after hybrid total knee arthroplasty. As such, the purpose of the current study was to describe the long-term results of total knee arthroplasty performed using the hybrid technique. The authors retrospectively reviewed a total of 77 hybrid total knee arthroplasties with at least 12 years of follow-up. Clinical and radiographic evaluations were performed to determine patient function and the incidence of femoral component failure after hybrid total knee arthroplasty. At the time of last follow-up, 76 of 77 (99%) of the femoral components remained in place without evidence of loosening. One femoral component failed due to aseptic loosening and was ultimately revised to a cemented femoral component without further complication. In addition, 1 tibial component and 2 patellar components failed due to aseptic loosening. Four tibial polyethylene liners were revised for polyethylene wear. In conclusion, press-fit fixation of the femoral component is a reliable and durable alternative to cemented fixation. [Orthopedics. 2016; 39(3):181-186.].

  15. Femoral Component Survival in Hybrid Total Knee Arthroplasty.

    PubMed

    Perry, Clayton R; Perry, Kevin I

    2016-05-01

    Although the majority of North American surgeons perform total knee arthroplasty by cementing both the femoral and the tibial components, hybrid fixation with a press-fit femur and cemented tibia is an alternative form of total knee arthroplasty performed by some. Currently, there is a paucity of literature evaluating long-term outcomes after hybrid total knee arthroplasty. As such, the purpose of the current study was to describe the long-term results of total knee arthroplasty performed using the hybrid technique. The authors retrospectively reviewed a total of 77 hybrid total knee arthroplasties with at least 12 years of follow-up. Clinical and radiographic evaluations were performed to determine patient function and the incidence of femoral component failure after hybrid total knee arthroplasty. At the time of last follow-up, 76 of 77 (99%) of the femoral components remained in place without evidence of loosening. One femoral component failed due to aseptic loosening and was ultimately revised to a cemented femoral component without further complication. In addition, 1 tibial component and 2 patellar components failed due to aseptic loosening. Four tibial polyethylene liners were revised for polyethylene wear. In conclusion, press-fit fixation of the femoral component is a reliable and durable alternative to cemented fixation. [Orthopedics. 2016; 39(3):181-186.]. PMID:27135453

  16. MIS unicondylar knee arthroplasty: surgical approach and early results.

    PubMed

    Gesell, Mark W; Tria, Alfred J

    2004-11-01

    Unicondylar arthroplasty of the knee has seen a resurgence of interest in the United States. The principles of unicondylar arthroplasty of the knee are different from those for total knee arthroplasty, allowing replacement of only the affected joint compartment with less bone loss. Minimally invasive surgery allows for less soft tissue dissection with the potential for less morbidity. The key question is: will the changes associated with the minimally invasive surgery procedure improve the clinical results of the standard unicondylar arthroplasty of the knee or will the changes make the procedure too difficult and lead to an increasing failure rate? This study reviews the surgical technique and presents the 2 to 4 year results of the minimally invasive unicondylar arthroplasty of the knee 47 knees in 41 patients. The average range of motion increased from 121 degrees -132 degrees . The Knee Society pain score improved from 45-80 and the function score improved from 47-78. Only one knee has been revised. With proper patient selection, minimally invasive unicondylar arthroplasty of the knee allows for results that are at least equal to those of the standard open procedure at 2 to 4 years after the surgery.

  17. Analysis and evaluation of a biomedical polycarbonate urethane tested in an in vitro study and an ovine arthroplasty model. Part I: materials selection and evaluation.

    PubMed

    Khan, Imran; Smith, Nigel; Jones, Eric; Finch, Dudley S; Cameron, Ruth Elizabeth

    2005-02-01

    The polyurethane elastomer (PU) Corethane 80A (Corvita) is being considered as the acetabular bearing material in a novel total replacement hip joint. The biostability of Corethane 80A was investigated in vitro (this work) and in vivo (reported separately) in a fully functioning ovine total hip arthroplasty (THA) model, with the PU as the bearing layer in a prototype compliant layer acetabular cup. The in vitro studies assessed the resistance of Corethane 80A to the main degradation mechanisms observed in PUs: hydrolysis, environmental stress cracking (ESC), metal ion oxidation (MIO) and calcification. The performance of the polycarbonate PU Corethane 80A was assessed alongside three other commercially available biomedical PUs: polyether PUs Pellethane 2363-80A (DOW Chemical) and PHMO-PU (CSIRO, not supplied as a commercial material) as well as polycarbonate PU ChronoFlex AL-80A (CardioTech). Chemical and structural variables that affect the properties of the materials were analysed with particular attention to the nature of the material's hard and soft segments. PU degradation was probed using a range of analytical tools and physical-testing methods, including mechanical testing, differential scanning calorimetry (DSC), Fourier transform infrared spectroscopy (FTIR) and environmental scanning microscopy (ESEM). Corethane 80A displayed the best overall resistance to hydrolysis, ESC, MIO and calcification, followed by ChronoFlex 80A and PHMO-PU. Pellethane 80A was the least stable. This study provides compelling evidence for the biostability and effectiveness of Corethane 80A and points to its suitability for use as a compliant bearing layer in hip arthroplasty, and possibly also other joints. PMID:15282140

  18. Analysis and evaluation of a biomedical polycarbonate urethane tested in an in vitro study and an ovine arthroplasty model. Part I: materials selection and evaluation.

    PubMed

    Khan, Imran; Smith, Nigel; Jones, Eric; Finch, Dudley S; Cameron, Ruth Elizabeth

    2005-02-01

    The polyurethane elastomer (PU) Corethane 80A (Corvita) is being considered as the acetabular bearing material in a novel total replacement hip joint. The biostability of Corethane 80A was investigated in vitro (this work) and in vivo (reported separately) in a fully functioning ovine total hip arthroplasty (THA) model, with the PU as the bearing layer in a prototype compliant layer acetabular cup. The in vitro studies assessed the resistance of Corethane 80A to the main degradation mechanisms observed in PUs: hydrolysis, environmental stress cracking (ESC), metal ion oxidation (MIO) and calcification. The performance of the polycarbonate PU Corethane 80A was assessed alongside three other commercially available biomedical PUs: polyether PUs Pellethane 2363-80A (DOW Chemical) and PHMO-PU (CSIRO, not supplied as a commercial material) as well as polycarbonate PU ChronoFlex AL-80A (CardioTech). Chemical and structural variables that affect the properties of the materials were analysed with particular attention to the nature of the material's hard and soft segments. PU degradation was probed using a range of analytical tools and physical-testing methods, including mechanical testing, differential scanning calorimetry (DSC), Fourier transform infrared spectroscopy (FTIR) and environmental scanning microscopy (ESEM). Corethane 80A displayed the best overall resistance to hydrolysis, ESC, MIO and calcification, followed by ChronoFlex 80A and PHMO-PU. Pellethane 80A was the least stable. This study provides compelling evidence for the biostability and effectiveness of Corethane 80A and points to its suitability for use as a compliant bearing layer in hip arthroplasty, and possibly also other joints.

  19. Application of Rapid Prototyping Pelvic Model for Patients with DDH to Facilitate Arthroplasty Planning: A Pilot Study.

    PubMed

    Xu, Jie; Li, Deng; Ma, Ruo-fan; Barden, Bertram; Ding, Yue

    2015-11-01

    Total hip arthroplasty (THA) is challenging in cases of osteoarthritis secondary to developmental dysplasia of the hip (DDH). Acetabular deficiency makes the positioning of the acetabular component difficult. Computer tomography based, patient-individual three dimensional (3-D) rapid prototype technology (RPT)-models were used to plan the placement of acetabular cup so that a surgeon was able to identify pelvic structures, assess the ideal extent of reaming and determine the size of cup after a reconstructive procedure. Intraclass correlation coefficients (ICCs) were used to analyze the agreement between the sizes of chosen components on the basis of preoperative planning and the actual sizes used in the operation. The use of the 3-D RPT-model facilitates the surgical procedures due to better planning and improved orientation. PMID:26129852

  20. Template-Directed Instrumentation Reduces Cost and Improves Efficiency for Total Knee Arthroplasty: An Economic Decision Analysis and Pilot Study.

    PubMed

    McLawhorn, Alexander S; Carroll, Kaitlin M; Blevins, Jason L; DeNegre, Scott T; Mayman, David J; Jerabek, Seth A

    2015-10-01

    Template-directed instrumentation (TDI) for total knee arthroplasty (TKA) may streamline operating room (OR) workflow and reduce costs by preselecting implants and minimizing instrument tray burden. A decision model simulated the economics of TDI. Sensitivity analyses determined thresholds for model variables to ensure TDI success. A clinical pilot was reviewed. The accuracy of preoperative templates was validated, and 20 consecutive primary TKAs were performed using TDI. The model determined that preoperative component size estimation should be accurate to ±1 implant size for 50% of TKAs to implement TDI. The pilot showed that preoperative template accuracy exceeded 97%. There were statistically significant improvements in OR turnover time and in-room time for TDI compared to an historical cohort of TKAs. TDI reduces costs and improves OR efficiency. PMID:26021908

  1. Template-Directed Instrumentation Reduces Cost and Improves Efficiency for Total Knee Arthroplasty: An Economic Decision Analysis and Pilot Study.

    PubMed

    McLawhorn, Alexander S; Carroll, Kaitlin M; Blevins, Jason L; DeNegre, Scott T; Mayman, David J; Jerabek, Seth A

    2015-10-01

    Template-directed instrumentation (TDI) for total knee arthroplasty (TKA) may streamline operating room (OR) workflow and reduce costs by preselecting implants and minimizing instrument tray burden. A decision model simulated the economics of TDI. Sensitivity analyses determined thresholds for model variables to ensure TDI success. A clinical pilot was reviewed. The accuracy of preoperative templates was validated, and 20 consecutive primary TKAs were performed using TDI. The model determined that preoperative component size estimation should be accurate to ±1 implant size for 50% of TKAs to implement TDI. The pilot showed that preoperative template accuracy exceeded 97%. There were statistically significant improvements in OR turnover time and in-room time for TDI compared to an historical cohort of TKAs. TDI reduces costs and improves OR efficiency.

  2. Intra-articular bupivacaine after joint arthroplasty: a systematic review and meta-analysis of randomised placebo-controlled studies

    PubMed Central

    Cui, Yang; Yang, Tuo; Zeng, Chao; Wei, Jie; Xie, Xi; Li, Liangjun; Ding, Xiang; Zhang, Yi; Lei, Guanghua

    2016-01-01

    Objectives To evaluate the efficacy and safety of intra-articular (IA) bupivacaine administered for pain relief after joint arthroplasty. Design Meta-analysis. Methods A systematic review was conducted to identify the randomised controlled trials using IA bupivacaine for postoperative pain relief from MEDLINE, Cochrane Library and EMBASE databases (up to October 2015). The standardised mean difference (SMD), the relative risk (RR) and their corresponding 95% CIs were calculated using the RevMan statistical software. Results A total of 11 randomised controlled trials were included. Statistically significant differences between IA bupivacaine and placebo were observed for the mean visual analogue scale (VAS) values (SMD −0.55; 95% CI −0.89 to −0.22; p<0.001) and narcotic consumption (SMD −0.32; 95% CI −0.55 to −0.08; p=0.008) during the period of 24 hours postoperatively and narcotic consumption during the period between 24 and 48 hours postoperatively (SMD −0.32; 95% CI −0.55 to −0.08; p=0.009). However, there was no significant difference in the mean VAS pain score during the period between 24  and 48 hours postoperatively (SMD −0.09, 95% CI −0.30 to 0.11; p=0.37) and in the incidence of adverse effects 24–72 hours postoperatively (RR 0.97; 95% CI 0.60 to 1.57; p=0.91). Conclusions The administration of IA bupivacaine after joint arthroplasty is effective for pain relief without increasing adverse effects. PMID:27406643

  3. Pharmacognostical and preliminary phytochemical studies of Passiflora foetida

    PubMed Central

    Krishnaveni, A.; Thaakur, Santh Rani

    2008-01-01

    The plant Passiflora foetida (grandilla) has been used mainly for asthma and various neurological disorders by the traditional medicinal practitioners of Chittor District. Since proper information regarding this plant is not available, our efforts were devoted to fix the pharmacognostical parameters and preliminary phytochemical studies of Passiflora foetid. An attempt was made to fix the macroscopical, microscopical parameters of the leaf, quantitative microscopy, physical constants, behaviour of the powder with chemical reagents and preliminary qualitative phytochemical studies of Passiflora foetida were investigated. The phytochemical tests revealed the presence of sterols, flavanoids and carbohydrates. PMID:22557273

  4. Pharmacognostical and preliminary phytochemical studies of Passiflora foetida.

    PubMed

    Krishnaveni, A; Thaakur, Santh Rani

    2008-01-01

    The plant Passiflora foetida (grandilla) has been used mainly for asthma and various neurological disorders by the traditional medicinal practitioners of Chittor District. Since proper information regarding this plant is not available, our efforts were devoted to fix the pharmacognostical parameters and preliminary phytochemical studies of Passiflora foetid. An attempt was made to fix the macroscopical, microscopical parameters of the leaf, quantitative microscopy, physical constants, behaviour of the powder with chemical reagents and preliminary qualitative phytochemical studies of Passiflora foetida were investigated. The phytochemical tests revealed the presence of sterols, flavanoids and carbohydrates. PMID:22557273

  5. A Preliminary Study of Career Education in Middle School

    ERIC Educational Resources Information Center

    Ting, S. R.; Leung, Y. F.; Stewart, K.; Smith, A. C.; Roberts, G. L.; Dees, S.

    2012-01-01

    This article reports a preliminary study on the Geosciences in Middle School, which was a career education program in the Southeastern U.S focusing on science based on Super's (1990) theory. The students (n = 80) were found to improve their interests in studying science, increase science knowledge, skills and awareness and highly satisfied with…

  6. Applying for Your Own Job: A Preliminary Study

    ERIC Educational Resources Information Center

    Boyd, Elizabeth Reid

    2008-01-01

    This study undertook a small preliminary investigation of the contemporary employment practice of "applying for your own job". There has not yet been a specific study into the effect upon individuals and organisations of the practice of existing employees being required to apply for the same or a similar position in a competitive application…

  7. Spirituality and the Events of September 11: A Preliminary Study

    ERIC Educational Resources Information Center

    Briggs, Michele Kielty; Apple, Kevin J.; Aydlett, Ann E.

    2004-01-01

    Personal crises have been associated with spiritual growth. Sparked by the global response to the crisis of September 11, 2001, this study examined the relationship of spirituality and the September 11 tragedy using a sample of convenience from a college student population. This preliminary study used an experimental design to examine various…

  8. Arthroplasty in Femoral Head Osteonecrosis

    PubMed Central

    Nam, Dong Cheol; Jung, Kwangyoung

    2014-01-01

    Osteonecrosis of the femoral head is a destructive joint disease requiring early hip arthroplasty. The polyethylene-metal design using a 22-mm femoral head component, introduced by Charnley in 1950, has been widely used for over half a century. Since then, different materials with the capacity to minimize friction between bearing surfaces and various cement or cementless insert fixations have been developed. Although the outcome of second and third generation designs using better bearing materials and technologies has been favorable, less favorable results are seen with total hip arthroplasty in young patients with osteonecrosis. Selection of appropriate materials for hip arthroplasty is important for any potential revisions that might become inevitable due to the limited durability of a prosthetic hip joint. Alternative hip arthroplasties, which include hemiresurfacing arthroplasty and bipolar hemiarthroplasty, have not been found to have acceptable outcomes. Metal-on-metal resurfacing has recently been suggested as a feasible option for young patients with extra physical demands; however, concerns about complications such as hypersensitivity reaction or pseudotumor formation on metal bearings have emerged. To ensure successful long-term outcomes in hip arthroplasty, factors such as insert stabilization and surfaces with less friction are essential. Understanding these aspects in arthroplasty is important to selection of proper materials and to making appropriate decisions for patients with osteonecrosis of the femoral head. PMID:27536561

  9. Radial head arthroplasty.

    PubMed

    Kleiner, M T; Ilyas, A M; Jupiter, J B

    2010-02-01

    In conclusion, radial head fractures with 3 or more fragments have a high incidence of complications when treated with ORIF including hardware failure, malunion, nonunion, and the need for re-operation. Radial head arthroplasty has demonstrated good success in the treatment of complex, comminuted radial head fractures which are not amenable to non-opeative treatment or ORIF. Success can be optimized by diligent surgical dissection, avoiding inadvertent nerve injury, placement of an appropriately sized implant, repair of associated injuries, and early protected motion. PMID:20214854

  10. Cementless total knee arthroplasty

    PubMed Central

    Risitano, Salvatore; Sabatini, Luigi; Giachino, Matteo; Agati, Gabriele; Massè, Alessandro

    2016-01-01

    Interest for uncemented total knee arthroplasty (TKA) has greatly increased in recent years. This technique, less used than cemented knee replacement in the last decades, sees a revival thanks an advance in prosthetic design, instrumentation and operative technique. The related literature in some cases shows conflicting data on survival and on the revision’s rate, but in most cases a success rate comparable to cemented TKA is reported. The optimal fixation in TKA is a subject of debate with the majority of surgeons favouring cemented fixation. PMID:27162779

  11. Early Attempts at Hip Arthroplasty

    PubMed Central

    Gomez, Pablo F; Morcuende, Jose A

    2005-01-01

    Over the last three centuries, treatment of hip arthritides has evolved from rudimentary surgery to modern total hip arthroplasty (THA), which is considered one of the most successful surgical interventions ever developed. We here review the history of the early hip arthroplasty procedures for hip arthritis that preceded Charley total hip arthroplasty. An evaluation of such past enterprises is relevant, and reminds us of the ephemeral nature of human industriousness, and how medical research and procedures are not isolated developments, but correlate to the social, economical, and cultural framework of their time. PMID:16089067

  12. Preliminary design studies of an advanced general aviation aircraft

    NASA Technical Reports Server (NTRS)

    Barrett, Ron; Demoss, Shane; Dirkzwager, AB; Evans, Darryl; Gomer, Charles; Keiter, Jerry; Knipp, Darren; Seier, Glen; Smith, Steve; Wenninger, ED

    1991-01-01

    The preliminary design results are presented of the advanced aircraft design project. The goal was to take a revolutionary look into the design of a general aviation aircraft. Phase 1 of the project included the preliminary design of two configurations, a pusher, and a tractor. Phase 2 included the selection of only one configuration for further study. The pusher configuration was selected on the basis of performance characteristics, cabin noise, natural laminar flow, and system layouts. The design was then iterated to achieve higher levels of performance.

  13. PRELIMINARY PHYTOCHEMICAL STUDIES ON SOLANUM SURATTENSE BURM.F. SEEDS

    PubMed Central

    Shahiladevi, S.; Jayanthi, G.; Jegadeesan, M.

    2006-01-01

    Solanum surattense Burm.f. has been largely used in the indigenous system of medicine. A preliminary pharmacognostical study of the seed has been undertaken and the physico-chemical, fluorescent and qualitative phytochemical tests have been worked out and the results were presented. PMID:22557226

  14. Preliminary Design Study of a Hybrid Airship for Flight Research

    NASA Technical Reports Server (NTRS)

    Browning, R. G. E.

    1981-01-01

    The feasibility of using components from four small helicopters and an airship envelope as the basis for a quad-rotor research aircraft was studied. Preliminary investigations included a review of candidate hardware and various combinations of rotor craft/airship configurations. A selected vehicle was analyzed to assess its structural and performance characteristics.

  15. PTSD and Impaired Eye Expression Recognition: A Preliminary Study

    ERIC Educational Resources Information Center

    Schmidt, Jakob Zeuthen; Zachariae, Robert

    2009-01-01

    This preliminary study examined whether posttraumatic stress disorder (PTSD) was related to difficulties in identifying the mental states of others in a group of refugees. Sixteen Bosnian refugees, referred to treatment in an outpatient treatment center for survivors of torture and war-related trauma in Denmark (CETT), were compared to 16 non-PTSD…

  16. Decreasing Public Smoking among Youth: A Preliminary Study

    ERIC Educational Resources Information Center

    Jason, Leonard A.; Pokorny, Steven B.; Turner, Paul L.; Freeland, Margaret; Corbin, Sara; Driscoll, Mark

    2005-01-01

    This brief paper reports the results of two observational studies examining the impact of fines for youth tobacco possession on public smoking among youth. Preliminary findings are presented that suggest that when police issued warnings and tickets to reduce underage youth possession of tobacco, in both towns the number of youth smoking in public…

  17. Preliminary simulation studies related to the Cerro Prieto Field

    SciTech Connect

    Lippmann, M.J.; Bodvarsson, G.S.; Witherspoon, P.A.; Rivera, J.R.

    1980-01-01

    Results of preliminary numerical simulations of the behavior of the Cerro Prieto field are discussed. The purpose of these studies is to examine: (1) the effect of using conventional isothermal methods of well test data analysis for geothermal systems, and (2) the influence of recharge from over under underlying aquifers on the temperature of a producing geothermal reservoir. 8 refs.

  18. Bladder management after total joint arthroplasty.

    PubMed

    Knight, R M; Pellegrini, V D

    1996-12-01

    This study was undertaken to determine the impact of an indwelling Foley catheter on bladder dysfunction and incidence of urinary tract infections after total joint arthroplasty. A prospective randomized controlled trial was conducted assigning use of an indwelling Foley catheter (group 1) or intermittent catheterization (group 2) for 48 hours following operation. Postoperative cultures were obtained on days 2 and 5, and the number of intermittent catheterization events and void and catheterization volumes were recorded. Concurrent cost-effectiveness analysis was conducted. One hundred nineteen of 174 consecutive patients having elective primary total joint arthroplasty completed the study. Five of 62 patients (8%) in group 1 and 7 of 57 patients (12%) in group 2 developed urinary tract infections (NS, P = 45). Twenty patients (35%) in group 2 and 12 (19%) in group 1 required straight catheterization for inability to void 48 hours after surgery (P = .05). Seventeen patients (35%) in group 2 and eight patients (16%) in group 1 required straight catheterization after epidural analgesia was discontinued (P = .024). Bladder management by indwelling Foley catheter saved more than 150 minutes of direct nursing contact per patient and $3,000 in total hospital costs. Indwelling Foley catheters reduced the frequency of postoperative urinary retention, were less labor intensive than intermittent straight catheterization, and were not associated with an increased risk of urinary infection. In the setting of epidural anesthesia and postoperative analgesia for total joint arthroplasty, management by indwelling catheter is a cost-effective strategy to facilitate postoperative return of normal bladder function.

  19. The epidemiology of revision total knee and hip arthroplasty in England and Wales: a comparative analysis with projections for the United States. A study using the National Joint Registry dataset.

    PubMed

    Patel, A; Pavlou, G; Mújica-Mota, R E; Toms, A D

    2015-08-01

    Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are recognised and proven interventions for patients with advanced arthritis. Studies to date have demonstrated a steady increase in the requirement for primary and revision procedures. Projected estimates made for the United States show that by 2030 the demand for primary TKA will grow by 673% and for revision TKA by 601% from the level in 2005. For THA the projected estimates are 174% and 137% for primary and revision surgery, respectively. The purpose of this study was to see if those predictions were similar for England and Wales using data from the National Joint Registry and the Office of National Statistics. Analysis of data for England and Wales suggest that by 2030, the volume of primary and revision TKAs will have increased by 117% and 332%, respectively between 2012 and 2030. The data for the United States translates to a 306% cumulative rate of increase between 2012 and 2030 for revision surgery, which is similar to our predictions for England and Wales. The predictions from the United States for primary TKA were similar to our upper limit projections. For THA, we predicted an increase of 134% and 31% for primary and revision hip surgery, respectively. Our model has limitations, however, it highlights the economic burden of arthroplasty in the future in England and Wales as a real and unaddressed problem. This will have significant implications for the provision of health care and the management of orthopaedic services in the future. PMID:26224824

  20. Unicompartmental knee arthroplasty

    PubMed Central

    Murray, D. W.; Liddle, A. D.; Dodd, C. A. F.; Pandit, H.

    2015-01-01

    There is a large amount of evidence available about the relative merits of unicompartmental and total knee arthroplasty (UKA and TKA). Based on the same evidence, different people draw different conclusions and as a result, there is great variability in the usage of UKA. The revision rate of UKA is much higher than TKA and so some surgeons conclude that UKA should not be performed. Other surgeons believe that the main reason for the high revision rate is that UKA is easy to revise and, therefore, the threshold for revision is low. They also believe that UKA has many advantages over TKA such as a faster recovery, lower morbidity and mortality and better function. They therefore conclude that UKA should be undertaken whenever appropriate. The solution to this argument is to minimise the revision rate of UKA, thereby addressing the main disadvantage of UKA. The evidence suggests that this will be achieved if surgeons use UKA for at least 20% of their knee arthroplasties and use implants that are appropriate for these broad indications. Cite this article: Bone Joint J 2015;97-B(10 Suppl A):3–8. PMID:26430080

  1. Autotransfusion--bacterial contamination during hip arthroplasty and efficacy of cefuroxime prophylaxis. A randomized controlled study of 40 patients.

    PubMed

    Wollinsky, K H; Oethinger, M; Büchele, M; Kluger, P; Puhl, W; Mehrkens, H H

    1997-06-01

    40 patients undergoing primary hip arthroplasty, given autologous processed blood transfusion, were randomized a receive no antibiotic prophylaxis (group A, n 20) or cefuroxime (1.5 g single injection; group B, n 20). Bacterial contamination at various steps in the autotransfusion procedure was assessed in liquid and solid culture media. The operation field and the wound drainage blood were never contaminated either of the groups but some of the suction tips were. Parts of the Vacufix blood collection bags of group A contained bacteria, but none in group B. Processed red blood cell concentrates in both groups showed bacterial growth. Greater blood loss did not increase the contamination rate in general. Isolated bacteria included the species Staphylococcus epidermidis, coagulase-negative staphylococci and Propionibacteria in both groups, but with different cell counts. In addition, Corynebacterium bovis et minutissimum and Moraxelle were identified in group A. In conclusion, autologous blood transfusion was a safe procedure. If contamination occurred, the bacterial count was low, and the bacteria of low pathogenicity. Antibiotic prophylaxis with cefuroxime reduced this contamination of suction tips and collection bags and limited the transfer of autologous blood products.

  2. Achieving ligament stability and correct rotational alignment of the femur in knee arthroplasty: a study using the Medial Pivot knee.

    PubMed

    Shakespeare, David; Kinzel, Vera; Ledger, Michael

    2005-12-01

    In a series of 90 Medial Pivot arthroplasties rotational alignment of the femur was achieved by provisionally reconstructing the lateral side of the joint and tensioning the medial side with feeler gauges. Axial CT scans were employed to measure the rotational alignment relative to surgical epicondylar axis. In valgus knees the cutting block was externally rotated to adjust for posterolateral bone loss. The mean rotational alignment of the femur was 0.6 degrees of external rotation (S.D. 1.3, range 3 degrees of ER to 4 degrees of IR). The mean laxity of the medial ligament was 1 mm in flexion (SD 1, range 0-5 mm) and 0.5 mm in flexion (S.D. 0.5, range 0-2 mm) In those knees in which the medial ligament had been released the CT alignment was perfect, but when internally rotated against the hip 3-4 mm of gapping was noted. In valgus knees the mean rotation of the femoral component was 0.8 degrees of internal rotation (S.D. 1.5, range 1 degrees of IR to 4 degrees of ER). In spite of externally rotating the cutting block there was still a tendency to internally rotate the femur in some knees. This simple technique achieves the two goals of ligament stability and correct rotational alignment in a high proportion of cases. It may be applicable to any instrument system which employs posterior referencing.

  3. Total hip arthroplasty revision in elderly patients.

    PubMed

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

    2013-10-01

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

  4. Caregivers with Visual Impairments: A Preliminary Study

    ERIC Educational Resources Information Center

    Fuhr, Patti; Martinez, Bethany; Williams, Michael

    2008-01-01

    Persons who are elderly, visually impaired, and primary caregivers for ailing or disabled spouses or significant others are a unique population that has not been studied previously. By definition, "informal caregivers" are family members or friends who provide unpaid day-to-day assistance with activities of daily living and are familiar with the…

  5. Preliminary shuttle structural dynamics modeling design study

    NASA Technical Reports Server (NTRS)

    1972-01-01

    The design and development of a structural dynamics model of the space shuttle are discussed. The model provides for early study of structural dynamics problems, permits evaluation of the accuracy of the structural and hydroelastic analysis methods used on test vehicles, and provides for efficiently evaluating potential cost savings in structural dynamic testing techniques. The discussion is developed around the modes in which major input forces and responses occur and the significant structural details in these modes.

  6. Preliminary Study for Technology Enhanced Learning: Comparative Study of England and Northern Cyprus

    ERIC Educational Resources Information Center

    Tenekeci, Ebru Heyberi

    2011-01-01

    The purpose of this paper is to present the preliminary study findings from an ongoing PhD study. In this paper, the researcher presents the preliminary study that was carried out with a number of schools in England and Northern Cyprus in order to identify the background or big pictures of each country in terms of available ICT tools that are…

  7. [Living with an ostomy: a preliminary study].

    PubMed

    Trentini, M; Pacheco, M A; Martins, M L; da Silva, D M; de Farias, S R; Duarte, R; Martins, J C; Tomaz, C E

    1992-07-01

    This study reveals some aspects of ostomy patients life experience. The data were obtained by using the participant observation technique during the monthly meeting session of the Ostomy Patients Association from July 1989 to August 1991. The findings showed that the ostomized patients were concerned with: 1) the ostomy pouch (how to get it); 2) other persons opinion about ostomized patients; 3) their sexuality, and stoma care. The patients perceived themselves as physically disable and inferior persons. Some of them perceived themselves as having a normal life. Other patients also had to cope with the stigma of cancer. PMID:1297161

  8. Preliminary design study of a baseline MIUS

    NASA Technical Reports Server (NTRS)

    Wolfer, B. M.; Shields, V. E.; Rippey, J. O.; Roberts, H. L.; Wadle, R. C.; Wallin, S. P.; Gill, W. L.; White, E. H.; Monzingo, R.

    1977-01-01

    Results of a conceptual design study to establish a baseline design for a modular integrated utility system (MIUS) are presented. The system concept developed a basis for evaluating possible projects to demonstrate an MIUS. For the baseline study, climate conditions for the Washington, D.C., area were used. The baseline design is for a high density apartment complex of 496 dwelling units with a planned full occupancy of approximately 1200 residents. Environmental considerations and regulations for the MIUS installation are discussed. Detailed cost data for the baseline MIUS are given together with those for design and operating variations under climate conditions typified by Las Vegas, Nevada, Houston, Texas, and Minneapolis, Minnesota. In addition, results of an investigation of size variation effects, for 300 and 1000 unit apartment complexes, are presented. Only conceptual aspects of the design are discussed. Results regarding energy savings and costs are intended only as trend information and for use in relative comparisons. Alternate heating, ventilation, and air conditioning concepts are considered in the appendix.

  9. A preliminary ultrasound study of velar fronting

    NASA Astrophysics Data System (ADS)

    Wodzinski, Sylvie M.; Frisch, Stefan A.

    2003-10-01

    The purpose of this study is to (1) evaluate the effectiveness of ultrasound imaging to measure velar consonant closure location, and (2) conduct a thorough study of velar fronting by measuring several productions of velar stops in the context of every English vowel. Word onset velar stops were measured in both words (CV or CVC) and nonwords (VCV) within a carrier phrase. Other coarticulatory influences were minimized by using words with no coda or labial coda consonants (e.g., ``Say a gap again,'' ``Say /oIkoI/ again''). Measurements were made at the point of maximal closure. Closure location was measured using the radial angle from the center of the ultrasound probe to the center of the velar closure. Pilot data for one subject has been analyzed to date. Closure location appears consistent across all central and back vowels. For front vowels, the degree of fronting of the velar appears to be correlated with the frontness of the vowel. Measures of closure location for diphthongs followed the back vowel pattern in the word targets. For nonwords, the closure location was influenced by the preceding diphthong offset quality and the following diphthong onset quality. Theoretical implications for the phonetics/phonology interface will be discussed.

  10. Arthroplasty Utilization in the United States is Predicted by Age-Specific Population Groups.

    PubMed

    Bashinskaya, Bronislava; Zimmerman, Ryan M; Walcott, Brian P; Antoci, Valentin

    2012-01-01

    Osteoarthritis is a common indication for hip and knee arthroplasty. An accurate assessment of current trends in healthcare utilization as they relate to arthroplasty may predict the needs of a growing elderly population in the United States. First, incidence data was queried from the United States Nationwide Inpatient Sample from 1993 to 2009. Patients undergoing total knee and hip arthroplasty were identified. Then, the United States Census Bureau was queried for population data from the same study period as well as to provide future projections. Arthroplasty followed linear regression models with the population group >64 years in both hip and knee groups. Projections for procedure incidence in the year 2050 based on these models were calculated to be 1,859,553 cases (hip) and 4,174,554 cases (knee). The need for hip and knee arthroplasty is expected to grow significantly in the upcoming years, given population growth predictions.

  11. ELIGIBILITY FOR THE HIP-RESURFACING ARTHROPLASTY PROCEDURE: AN EVALUATION ON 592 HIPS

    PubMed Central

    Queiroz, Roberto Dantas; Faria, Rafael Salomon Silva; Duarte, David Marcelo; Takano, Marcelo Itiro; Sugiyama, Mauricio Morita

    2015-01-01

    Objective: To investigate the percentage of ideal patients who would be eligible for hip-resurfacing surgery at a reference service for hip arthroplasty. Methods: Out of all the cases of hip arthroplasty operated at Hospital do Servidor Público Estadual de São Paulo (HSPE) between January 2009 and December 2010, we assessed a total of 592 procedures that would fit the criteria for indication for resurfacing arthroplasty, after clinical and radiological evaluation according to the criteria established by the Food and Drug Administration (FDA) and by Seyler et al. Results: Among the total number of hip replacement arthroplasty cases, 5.74% of the patients were eligible. Among the patients who underwent primary arthroplasty, we found that 8.23% presented ideal conditions for this procedure. Conclusion: The study demonstrated that this type of surgery still has a limited role among hip surgery methods. PMID:27047851

  12. Preliminary systems design study assessment report

    SciTech Connect

    Mayberry, J.L.; Feizollahi, F.; Del Signore, J.C.

    1991-10-01

    The System Design Study (SDS), part of the Waste Technology Development Department of the Idaho National Engineering Laboratory (INEL), examined techniques available for the remediation of hazardous and transuranic waste stored at the Radioactive Waste Management Complex's Subsurface Disposal Area at the INEL. Using specific technologies, system concepts for treating the buried waste and the surrounding contaminated soil were evaluated. Evaluation included implementability, effectiveness, and cost. The SDS resulted in the development of technology requirements including demonstration, testing, and evaluation activities needed for implementing each concept. The SDS results are published in eight volumes. Volume I contains an executive summary. The SDS summary and analysis of results are presented in Volume II. Volumes III through VII contain descriptions of twelve system and four subsystem concepts. Volume VIII contains the appendixes.

  13. [Post-transfusional hepatitis. Preliminary study].

    PubMed

    León, G; Sore, A; Celis, S; Semprúm, O; Acosta, V; Gómez, O

    1991-04-01

    In Venezuela post-transfusional hepatitis (PTH) data is unknown. We studied, prospectively, 147 patients who received blood transfusions (1 to 48 different blood components). They were screened for HBsAg (Ortho HBsAg Elisa Test System), anti HBc (Ortho HBc Elisa Test System and CORZYME, Abbott Laboratories) and amino-transferases (Doles), before and after transfusions. Only the last 36 patients were tested for anti HCV (Ortho HCV antibody Elisa Test)R from the beginning. The test were performed at 2, 7, 12 and 24 weeks subsequently in the negative recipients. PTH for type B virus was 3.8% (5/131), and for NANBH 2.7% (3/110). In both groups those recipients who had more transfusions had the greatest incidence of PTH. We conclude that anti HBc and ALT must be done in all blood donors to prevent the occurrence of PTH either B virus or NANBH. We suggest also, to include anti HCV screening in blood donors as a mean to make blood transfusion safer.

  14. Relationship Between Patient Expectations and Clinical Measures in Patients Undergoing Rheumatoid Hand Surgery from the Silicone Arthroplasty in Rheumatoid Arthritis (SARA) Study

    PubMed Central

    Sears, Erika D.; Burns, Patricia B.; Chung, Kevin C.

    2016-01-01

    Background The purpose of this study is to evaluate the relationship between preoperative patient expectations and clinical measures in patients undergoing rheumatoid hand surgery. Methods Patients were recruited as a part of a larger prospective multicenter study to evaluate outcomes of silicone metacarpophalangeal joint arthroplasty (SMPA). Patients in the surgical cohort completed a baseline expectation questionnaire asking about expectations for function, work, pain, and aesthetics after SMPA. Responses were categorized into low, middle, and high expectations groups for each domain and for cumulative expectations across all domains. Other study measurements were taken at baseline and 1-year, including the Michigan Hand Outcomes Questionnaire (MHQ) and objective clinical measurements (grip strength, pinch strength, the Jebson-Taylor Hand Function Test, ulnar drift, and extensor lag). Results Preoperative expectations and clinical measures were complete for 59 patients at baseline and 45 patients at 1-year follow-up. Preoperative expectation level was related to baseline patient-reported domains of ADL and hand satisfaction measured by MHQ (P=0.04 and P=0.07 respectively). Patients had relatively similar satisfaction with hand function postoperatively regardless of preoperative expectation level. No consistent relationship was seen between preoperative expectations and objective measures at baseline and 1-year follow-up. Conclusions High preoperative expectations were not a risk factor for dissatisfaction postoperatively. Preoperative expectation level may be considered to stratify baseline patient-reported hand function in patients with similar objective hand function. Level of Evidence Level II Prognostic PMID:26595031

  15. Microorganisms associated particulate matter: a preliminary study.

    PubMed

    Alghamdi, Mansour A; Shamy, Magdy; Redal, Maria Ana; Khoder, Mamdouh; Awad, Abdel Hameed; Elserougy, Safaa

    2014-05-01

    This study aims to determine the microbiological quality of particulate matter (PM) in an urban area in Jeddah, Saudi Arabia, during December 2012 to April 2013. This was achieved by the determination of airborne bacteria, fungi, and actinobacteria associated PM10 and PM2.5, as well as their relationships with gaseous pollutants, O3, SO2 and NO2, and meteorological factors (T°C, RH% and Ws). High volume samplers with PM10 and PM2.5 selective sizes, and glass fiber filters were used to collect PM10 and PM2.5, respectively. The filters were suspended in buffer phosphate and aliquots were spread plated onto the surfaces of trypticase soy agar, malt extract agar, and starch casein agar media for counting of bacteria, fungi and actinobacteria-associated PM, respectively. PM10 and PM2.5 concentrations averaged 159.9 μg/m(3) and 60 μg/m(3), respectively, with the ratio of PM2.5/PM10 averaged ~0.4. The concentrations of O3, SO2 and NO2 averaged 35.73 μg/m(3), 38.1μg/m(3) and 52.5 μg/m(3), respectively. Fungi and actinobacteria associated PM were found in lower concentrations than bacteria. The sum of microbial loads was higher in PM10 than PM2.5, however a significant correlation (r=0.57, P ≤ 0.05) was found between the sum of microbial loads associated PM10 and PM2.5. Aspergillus fumigatus and Aspergillus niger were the common fungal types associated PM. Temperature significantly correlated with both PM10 (r=0.44), and PM2.5 (r=0.5). Significant negative correlations were found between O3 and PM2.5 (r=-0.47), and between SO2 with PM10 (r=-0.48). Wind speed positively correlated with airborne microorganisms associated PM. The regression model showed that the inverse PM2.5 concentration (1/PM2.5) was a significant determinant of fungal count associated PM. Chemical processes and environmental factors could affect properties of PM and in turn its biological quality.

  16. Hip arthroplasty for failed treatment of proximal femoral fractures.

    PubMed

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

    2010-10-01

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

  17. Similar incidence of periprosthetic fluid collections after ceramic-on-polyethylene total hip arthroplasties and metal-on-metal resurfacing arthroplasties: results of a screening metal artefact reduction sequence-MRI study.

    PubMed

    Bisseling, P; de Wit, B W K; Hol, A M; van Gorp, M J; van Kampen, A; van Susante, J L C

    2015-09-01

    Patients from a randomised trial on resurfacing hip arthroplasty (RHA) (n = 36, 19 males; median age 57 years, 24 to 65) comparing a conventional 28 mm metal-on-metal total hip arthroplasty (MoM THA) (n = 28, 17 males; median age 59 years, 37 to 65) and a matched control group of asymptomatic patients with a 32 mm ceramic-on-polyethylene (CoP) THA (n = 33, 18 males; median age 63 years, 38 to 71) were cross-sectionally screened with metal artefact reducing sequence-MRI (MARS-MRI) for pseudotumour formation at a median of 55 months (23 to 72) post-operatively. MRIs were scored by consensus according to three different classification systems for pseudotumour formation. Clinical scores were available for all patients and metal ion levels for MoM bearing patients. Periprosthetic lesions with a median volume of 16 mL (1.5 to 35.9) were diagnosed in six patients in the RHA group (17%), one in the MoM THA group (4%) and six in the CoP group (18%). The classification systems revealed no clear differences between the groups. Solid lesions (n = 3) were exclusively encountered in the RHA group. Two patients in the RHA group and one in the MoM THA group underwent a revision for pseudotumour formation. There was no statistically significant relationship between clinical scoring, metal ion levels and periprosthetic lesions in any of the groups. Periprosthetic fluid collections are seen on MARS-MRI after conventional CoP THA and RHA and may reflect a soft-tissue collection or effusion. Currently available MRI classification systems seem to score these collections as pseudotumours, causing an-overestimatation of the incidence of pseudotumours. PMID:26330582

  18. Lifetime cost effectiveness of different brands of prosthesis used for total hip arthroplasty: a study using the NJR dataset.

    PubMed

    Pennington, M W; Grieve, R; van der Meulen, J H

    2015-06-01

    There is little evidence on the cost effectiveness of different brands of hip prostheses. We compared lifetime cost effectiveness of frequently used brands within types of prosthesis including cemented (Exeter V40 Contemporary, Exeter V40 Duration and Exeter V40 Elite Plus Ogee), cementless (Corail Pinnacle, Accolade Trident, and Taperloc Exceed) and hybrid (Exeter V40 Trilogy, Exeter V40 Trident, and CPT Trilogy). We used data from three linked English national databases to estimate the lifetime risk of revision, quality-adjusted life years (QALYs) and cost. For women with osteoarthritis aged 70 years, the Exeter V40 Elite Plus Ogee had the lowest risk of revision (5.9% revision risk, 9.0 QALYs) and the CPT Trilogy had the highest QALYs (10.9% revision risk, 9.3 QALYs). Compared with the Corail Pinnacle (9.3% revision risk, 9.22 QALYs), the most commonly used brand, and assuming a willingness-to-pay of £20,000 per QALY gain, the CPT Trilogy is most cost effective, with an incremental net monetary benefit of £876. Differences in cost effectiveness between the hybrid CPT Trilogy and Exeter V40 Trident and the cementless Corail Pinnacle and Taperloc Exceed were small, and a cautious interpretation is required, given the limitations of the available information. However, it is unlikely that cemented brands are among the most cost effective. Similar patterns of results were observed for men and other ages. The gain in quality of life after total hip arthroplasty, rather than the risk of revision, was the main driver of cost effectiveness. Cite this article: Bone Joint J 2015;97-B:762-70. PMID:26033055

  19. The influence of total knee arthroplasty geometry on mid-flexion stability: an experimental and finite element study.

    PubMed

    Clary, Chadd W; Fitzpatrick, Clare K; Maletsky, Lorin P; Rullkoetter, Paul J

    2013-04-26

    Fluoroscopic evaluation of total knee arthroplasty (TKA) has reported sudden anterior translation of the femur relative to the tibia (paradoxical anterior motion) for some cruciate-retaining designs. This motion may be tied to abrupt changes in the femoral sagittal radius of curvature characteristic of traditional TKA designs, as the geometry transitions from a large load-bearing distal radius to a smaller posterior radius which can accommodate femoral rollback. It was hypothesized that a gradually reducing radius may attenuate sudden changes in anterior-posterior motion that occur in mid-flexion with traditional discrete-radius designs. A combined experimental and computational approach was employed to test this hypothesis. A previously developed finite element (FE) model of the Kansas knee simulator (KKS), virtually implanted with multiple implant designs, was used to predict the amount of paradoxical anterior femoral slide during a simulated deep knee bend. The model predicted kinematics demonstrated that incorporating a gradually reducing radius in mid-flexion reduced the magnitude of paradoxical anterior translation between 21% and 68%, depending on the conformity of the tibial insert. Subsequently, both a dual-radius design and a modified design incorporating gradually reducing radii were tested in vitro in the KKS for verification. The model-predicted and experimentally observed kinematics exhibited good agreement, while the average experimental kinematics demonstrated an 81% reduction in anterior translation with the modified design. The FE model demonstrated sufficient sensitivity to appropriately differentiate kinematic changes due to subtle changes in implant design, and served as a useful pre-clinical design-phase tool to improve implant kinematics. PMID:23499227

  20. Patient-Specific CT-Based Instrumentation versus Conventional Instrumentation in Total Knee Arthroplasty: A Prospective Randomized Controlled Study on Clinical Outcomes and In-Hospital Data

    PubMed Central

    Kotela, Andrzej; Lorkowski, Jacek; Kucharzewski, Marek; Wilk-Frańczuk, Magdalena; Śliwiński, Zbigniew; Frańczuk, Bogusław; Łęgosz, Paweł  ; Kotela, Ireneusz

    2015-01-01

    Total knee arthroplasty (TKA) is a frequently performed procedure in orthopaedic surgery. Recently, patient-specific instrumentation was introduced to facilitate correct positioning of implants. The aim of this study was to compare the early clinical results of TKA performed with patient-specific CT-based instrumentation and conventional technique. A prospective, randomized controlled trial on 112 patients was performed between January 2011 and December 2011. A group of 112 patients who met the inclusion and exclusion criteria were enrolled in this study and randomly assigned to an experimental or control group. The experimental group comprised 52 patients who received the Signature CT-based implant positioning system, and the control group consisted of 60 patients with conventional instrumentation. Clinical outcomes were evaluated with the KSS scale, WOMAC scale, and VAS scales to assess knee pain severity and patient satisfaction with the surgery. Specified in-hospital data were recorded. Patients were followed up for 12 months. At one year after surgery, there were no statistically significant differences between groups with respect to clinical outcomes and in-hospital data, including operative time, blood loss, hospital length of stay, intraoperative observations, and postoperative complications. Further high-quality investigations of various patient-specific systems and longer follow-up may be helpful in assessing their utility for TKA. PMID:26301241

  1. The Effect of Intraoperative Sounds of Saw and Hammer on Psychological Condition in Patients with Total Knee Arthroplasty: Prospective Randomized Study

    PubMed Central

    Kömürcü, Erkam; Kaymaz, Burak; Gölge, Umut Hatay; Nusran, Gürdal; Göksel, Ferdi; Şahin, Hasan; Ömür, Dilek; Hancı, Volkan

    2015-01-01

    Purpose. Surgical procedures are likely to be stressful for patients and their families. Total knee arthroplasty (TKA) is a major surgical procedure used in the treatment of osteoarthritis. During this procedure the sounds of the saw and hammer may irritate the patient and adversely affect mood. The present study examines the effect of these intraoperative sounds during TKA on postoperative mood and anxiety, by comparing two different anesthetic procedures. Methods. A total of 40 patients who underwent TKA for grade IV gonarthrosis participated in the study. Patients were randomly divided into two groups: 20 patients in the general anesthesia group and 20 patients in the spinal anesthesia group. Mood and anxiety changes were evaluated using the Profile of Mood States (POMS) and State-Trait Anxiety Inventory (STAI) instruments, respectively. Results. The postoperative POMS value in the spinal anesthesia group was definitively higher than the general anesthesia group, though the difference in preoperative and postoperative POMS and STAI scores between the two groups was not significant. Conclusion. It would seem that sounds of hammer and saw have no evident negative effect on patient's mood. Regional anesthesia is advisable for TKA patients and appropriate sedation can be administered during the operation if needed. PMID:25793222

  2. Relationship between self-reported pain sensitivity and pain after total knee arthroplasty: a prospective study of 71 patients 8 weeks after a standardized fast-track program

    PubMed Central

    Valeberg, Berit T; Høvik, Lise H; Gjeilo, Kari H

    2016-01-01

    Background and purpose This was a prospective cohort study assessing data from 71 adult patients undergoing total knee arthroplasty (TKA) following a standardized fast-track program between January and July 2013. The objective was to examine the relationship between self-rated pain sensitivity, as measured by the Pain Sensitivity Questionnaire (PSQ), and postoperative pain after TKA. Methods The baseline questionnaires, PSQ and Brief Pain Inventory, were given to the patients for self-administration at the presurgical evaluation (1–2 weeks prior to surgery). The follow-up questionnaire, Brief Pain Inventory, was administered at the first follow-up, 8 weeks after surgery. Results A statistically significant association was found between average preoperative pain and average pain 8 weeks after surgery (P=0.001). The PSQ-minor was statistically significantly associated with average pain only for patients younger than 70 years (P=0.03). Interpretation This is the first study to examine the relationship between pain sensitivity measured by PSQ and postoperative pain in patients after TKA. We found that a lower score on the PSQ-minor was statistically significantly associated with patients’ pain 8 weeks after TKA surgery, but only for younger patients. Further research is needed to explore whether the PSQ could be a useful screening tool for patients’ pain sensitivity in clinical settings.

  3. Relationship between self-reported pain sensitivity and pain after total knee arthroplasty: a prospective study of 71 patients 8 weeks after a standardized fast-track program

    PubMed Central

    Valeberg, Berit T; Høvik, Lise H; Gjeilo, Kari H

    2016-01-01

    Background and purpose This was a prospective cohort study assessing data from 71 adult patients undergoing total knee arthroplasty (TKA) following a standardized fast-track program between January and July 2013. The objective was to examine the relationship between self-rated pain sensitivity, as measured by the Pain Sensitivity Questionnaire (PSQ), and postoperative pain after TKA. Methods The baseline questionnaires, PSQ and Brief Pain Inventory, were given to the patients for self-administration at the presurgical evaluation (1–2 weeks prior to surgery). The follow-up questionnaire, Brief Pain Inventory, was administered at the first follow-up, 8 weeks after surgery. Results A statistically significant association was found between average preoperative pain and average pain 8 weeks after surgery (P=0.001). The PSQ-minor was statistically significantly associated with average pain only for patients younger than 70 years (P=0.03). Interpretation This is the first study to examine the relationship between pain sensitivity measured by PSQ and postoperative pain in patients after TKA. We found that a lower score on the PSQ-minor was statistically significantly associated with patients’ pain 8 weeks after TKA surgery, but only for younger patients. Further research is needed to explore whether the PSQ could be a useful screening tool for patients’ pain sensitivity in clinical settings. PMID:27660489

  4. Uncemented total hip arthroplasty in osteoarthritis of hip secondary to low and high dislocated hips: A mid-term follow-up study

    PubMed Central

    Munigangaiah, Sudarshan; O’Dwyer, Sinead; Masterson, Eric

    2016-01-01

    Background: Performing successful total hip replacement (THR) in dysplastic, subluxed, and dislocated hip is a challenging task. Here, we assessed midterm clinical and radiological outcomes of uncemented total hip arthroplasty in osteoarthritis (OA) of hip secondary to Hartofilakidis low and high-dislocated hips with a mean follow-up of 8.8 years. Materials and Methods: A retrospective study of prospectively collected data was designed involving all consecutive patients who underwent uncemented THR for OA of hip secondary to developmental dysplasia of the hip and Grade II or Grade III Hartofilakidis classification. Results: Thirty-two patients underwent 45 THR, with 23 Grade II (low dislocation) and 22 Grade III (high-dislocation) of Hartofilakidis classification. Thirteen patients had bilateral hip replacements, 19 patients had unilateral THR. There was highly statistically significant difference between preoperative and postoperative HHS and SF-36v2™ at each follow-up. Survivorship of original implant was 98.88% at a mean follow-up of 8.8 years. The mean improvement in leg length in this series was 3.6 cm (1.8-4.5, 95% confidence interval). No sciatic nerve or femoral nerve palsies were observed. Conclusions: Uncemented THR provides better function and quality of life. However, longer follow-up studies are needed to assess survivorship of uncemented THR in Hartofilakidis low and high-dislocations. PMID:27433063

  5. Arthroscopic bursectomy for recalcitrant trochanteric bursitis after hip arthroplasty.

    PubMed

    Van Hofwegen, Christopher; Baker, Champ L; Savory, Carlton G; Baker, Champ L

    2013-01-01

    This study evaluated the use of arthroscopic bursectomy for pain relief in patients with trochanteric bursitis after hip arthroplasty. In this retrospective case series of 12 patients undergoing arthroscopic treatment of recalcitrant trochanteric bursitis after hip arthroplasty, outcomes were assessed via phone interview with a numeric pain rating scale from 1 to 10 and were compared with preoperative pain ratings. Patients were asked the percentage of time they had painless hip function and whether they would have the surgery again. At an average 36-month follow-up (range, 4-85 months), the average numeric pain scale rating improved from 9.3 to 3.3. At an average of 62% of the time, patients had painless use of the hip. Ten of 12 patients in the study felt the pain relief gained was substantial enough to warrant having procedure again. In these patients, arthroscopic bursectomy was a viable option for patients with recalcitrant bursitis after hip arthroplasty. PMID:23628567

  6. Preliminary dose comparisons for the MRS Systems Study

    SciTech Connect

    Pelto, P.J.; Lavender, J.C.

    1989-04-01

    This report provides preliminary information on the radiological doses to the public and the workers for alternative system configurations proposed in the MRS Systems Study. Information published in the MRS Environmental Assessment (DOE 1986) was used as a basis for this analysis. The risk differences between alternative configurations were found to be small and should not be viewed as a major factor in selecting alternative configurations. 1 ref.

  7. Deproteinated palm kernel cake-derived oligosaccharides: A preliminary study

    NASA Astrophysics Data System (ADS)

    Fan, Suet Pin; Chia, Chin Hua; Fang, Zhen; Zakaria, Sarani; Chee, Kah Leong

    2014-09-01

    Preliminary study on microwave-assisted hydrolysis of deproteinated palm kernel cake (DPKC) to produce oligosaccharides using succinic acid was performed. Three important factors, i.e., temperature, acid concentration and reaction time, were selected to carry out the hydrolysis processes. Results showed that the highest yield of DPKC-derived oligosaccharides can be obtained at a parameter 170 °C, 0.2 N SA and 20 min of reaction time.

  8. Preliminary study of niobium alloy contamination by transport through helium

    NASA Technical Reports Server (NTRS)

    Scheuermann, C. M.; Moore, T. J.; Wheeler, D. R.

    1987-01-01

    Transport of gaseous contaminants through the working fluid to or from sensitive refractory alloys is theoretically possible during long time operation of Brayton and Stirling space power generation systems which use a gas as the working fluid. A test was designed which could give an answer to whether transport of contaminants through the working fluid was a potential major problem. The findings of that preliminary study are summarized.

  9. [Biomechanical analysis of different ProDisc-C arthroplasty design parameters after implanted: a numerical sensitivity study based on finite element method].

    PubMed

    Tang, Qiaohong; Mo, Zhongjun; Yao, Jie; Li, Qi; Du, Chenfei; Wang, Lizhen; Fan, Yubo

    2014-12-01

    This study was aimed to estimate the effect of different ProDisc-C arthroplasty designs after it was implanted to C5-C6 cervicalspine. Finite element (FE) model of intact C5-C6 segments including the vertebrae and disc was developed and validated. Ball-and-socket artificial disc prosthesis model (ProDisc-C, Synthes) was implanted into the validated FE model and the curvature of the ProDisc-C prosthesis was varied. All models were loaded with compressed force 74 N and the pure moment of 1.8 Nm along flexion-extension and bilateral bending and axial torsion separately. The results indicated that the variation in the curvature of ball and socket configuration would influence the range of motion in flexion/extension, while there were not apparently differences under other conditions of loads. The method increasing the curvature will solve the stress concentration of the polyethylene, but it will also bring adverse outcomes, such as facet joint force increasing and ligament tension increasing. Therefore, the design of artificial discs should be considered comprehensively to reserve the range of motion as well as to avoid the adverse problems, so as not to affect the long-term clinical results.

  10. Tranexamic acid reduces blood loss and need of blood transfusion in total knee arthroplasty: A prospective, randomized, double-blind study in Indian population

    PubMed Central

    Shinde, Abhishek; Sobti, Anshul; Maniar, Shriji; Mishra, Amit; Gite, Raju; Shetty, Vivek

    2015-01-01

    Introduction: For quite a few years, tranexamic acid (TEA) has been used during total knee arthroplasty (TKA) to reduce blood loss. However, no consensus exits regarding its timing and doses. Materials and Methods: We conducted a prospective, randomized double-blinded study of 56 patients in the Indian population undergoing TKA from 2011 to 2012. A dose of 10 mg/kg body weight of TEA (three doses) was given in one group and normal saline was administered in the other. Results: The mean blood loss in the TEA unilateral group was 295 mL ± 218 mL and in the placebo group was 482 mL ± 186 mL (P < 0.005). In the bilateral TEA group, the mean blood loss was 596 mL ± 235 mL and in the placebo group was 1349 mL ± 41 mL (P < 0.005). Conclusion: The number of patients requiring blood transfusion reduced substantially. There was no increase in the risk of deep vein thrombosis (DVT) and pulmonary embolism. TEA reduces intraoperative and postoperative blood loss and thus reduces the need of allogenic blood transfusion. PMID:26420938

  11. Effect of Closed Suction Drain on Blood Loss and Transfusion Rates in Simultaneous Bilateral Total Knee Arthroplasty: A Prospective Randomized Study

    PubMed Central

    Shetty, Gautam M.; Gupta, Vinay; Saxena, Purvi; Singh, Nidhi

    2016-01-01

    Purpose Simultaneous bilateral total knee arthroplasty (TKA) is associated with excessive blood loss and morbidity arising from postoperative reduction in hemoglobin (Hb). The purpose of this prospective randomized study was to determine if drains have any effect on blood loss, postoperative reduction in Hb levels and transfusion rates compared to no drainage in simultaneous bilateral TKAs. Materials and Methods Two hundred and thirty patients who underwent simultaneous bilateral TKA by a single surgeon were randomly allotted to drain or no-drain group (n=115 in each group). Postoperative Hb level, blood loss volume and transfusion rate were compared between the two groups. Results The mean postoperative Hb level (p=0.38), blood loss volume (p=0.33) and transfusion rate (p=0.52) in the drain group were not significantly different compared to the no-drain group. No statistical difference was found in terms of complications, readmissions and mortality rates between the two groups. Conclusions No significant difference was observed in the two groups with respect to blood loss and blood transfusion. Non-drainage does not offer an advantage over drainage with respect to conserving blood in simultaneous bilateral TKA. PMID:27595073

  12. Factors Related to Postoperative Pain Trajectories following Total Knee Arthroplasty: A Longitudinal Study of Patients Admitted to a Russian Orthopaedic Clinic

    PubMed Central

    Kornilov, Nikolai; Lindberg, Maren Falch; Gay, Caryl; Saraev, Alexander; Kuliaba, Taras; Rosseland, Leiv Arne; Muniz, Konstantin; Lerdal, Anners

    2016-01-01

    This study explores sociodemographic, clinical, and surgical factors in relation to pain trajectories during the first 3 days following total knee arthroplasty (TKA). 100 patients (mean age 63.5 ± 7.8 years and 93% female) consecutively admitted for uncomplicated primary TKA were prospectively included. Postoperative pain was assessed using pain diaries. Measures of preoperative pain, symptoms, daily functioning, quality of life, comorbidities, knee function, perioperative characteristics, and physical/biochemical parameters were also evaluated. All pain ratings decreased in the three days following surgery (p < .001) as well as the reported number of daily hours in moderate/severe pain (p < .001). Women reported more pain than men (p = .009). Pain trajectories did not differ by education, employment, cohabitation, or any patient clinical and biochemical characteristics but were significantly related to preoperative anxiety (p = .029). Patients reporting moderate/severe pain prior to surgery also reported more hours in moderate/severe pain on days 0–3 postoperatively (p = .029). Patients with surgeries longer than 90 min reported more hours of moderate/severe pain compared with patients who had shorter surgeries (p = .008), and similar results were observed for ratings of pain with activity (p = .012). In this sample, only female gender, higher levels of preoperative pain and anxiety, and longer surgical duration were associated with increased pain after TKA. PMID:26885390

  13. Bacterial Findings in Infected Hip Joint Replacements in Patients with Rheumatoid Arthritis and Osteoarthritis: A Study of 318 Revisions for Infection Reported to the Norwegian Arthroplasty Register

    PubMed Central

    Schrama, J. C.; Lutro, O.; Langvatn, H.; Hallan, G.; Espehaug, B.; Sjursen, H.; Engesaeter, L. B.; Fevang, B.-T.

    2012-01-01

    High rates of Staphylococcus aureus are reported in prosthetic joint infection (PJI) in rheumatoid arthritis (RA). RA patients are considered to have a high risk of infection with bacteria of potentially oral or dental origin. One thousand four hundred forty-three revisions for infection were reported to the Norwegian Arthroplasty Register (NAR) from 1987 to 2007. For this study 269 infection episodes in 255 OA patients served as control group. In the NAR we identified 49 infection episodes in 37 RA patients from 1987 to 2009. The RA patients were, on average, 10 years younger than the OA patients and there were more females (70% versus 54%). We found no differences in the bacterial findings in RA and OA. A tendency towards a higher frequency of Staphylococcus aureus (18% versus 11%) causing PJI was found in the RA patients compared to OA. There were no bacteria of potential odontogenic origin found in the RA patients, while we found 4% in OA. The bacteria identified in revisions for infection in THRs in patients with RA did not significantly differ from those in OA. Bacteria of oral or dental origin were not found in infected hip joint replacements in RA. PMID:24977078

  14. Mini-midvastus vs standard medial parapatellar approach: a prospective, randomized, double-blinded study in patients undergoing bilateral total knee arthroplasty.

    PubMed

    Nestor, Bryan J; Toulson, Charles E; Backus, Sherry I; Lyman, Stephen L; Foote, Kristin L; Windsor, Russell E

    2010-09-01

    The purpose of this study was to determine whether the mini-midvastus approach to total knee arthroplasty (TKA) results in differences in quadriceps muscle strength as well as previously cited advantages in a double blind prospective randomized trial. Twenty-seven patients (54 TKAs) scheduled for bilateral TKA were randomized to undergo mini-midvastus approach on one knee and standard approach on the other. Incision lengths were the same. Postoperative strength was determined by isokinetic and isometric peak torque testing. Range of motion, pain Visual analog scale, side-preference, and gait analysis were assessed preoperatively and postoperatively. The only significant difference in strength testing was increased isokinetic and isometric extension torque at 3 weeks postoperatively for the mini-midvastus approach. No differences between the mini-midvastus and standard approach were observed for stride length, stance time, pain Visual analog scale, or knee range of motion. The mini-midvastus approach has limited benefit compared to the standard approach for TKA.

  15. Quantification of material loss from the neck piece taper junctions of a bimodular primary hip prosthesis. A retrieval study from 27 failed Rejuvenate bimodular hip arthroplasties.

    PubMed

    Buente, D; Huber, G; Bishop, N; Morlock, M

    2015-10-01

    The early failure and revision of bimodular primary total hip arthroplasty prostheses requires the identification of the risk factors for material loss and wear at the taper junctions through taper wear analysis. Deviations in taper geometries between revised and pristine modular neck tapers were determined using high resolution tactile measurements. A new algorithm was developed and validated to allow the quantitative analysis of material loss, complementing the standard visual inspection currently used. The algorithm was applied to a sample of 27 retrievals (in situ from 2.9 to 38.1 months) of the withdrawn Rejuvenate modular prosthesis. The mean wear volumes on the flat distal neck piece taper was 3.35 mm(3) (0.55 to 7.57), mainly occurring in a characteristic pattern in areas with high mechanical loading. Wear volume tended to increase with time to revision (r² = 0.423, p = 0.001). Implant and patient specific data (offset, stem size, patient's mass, age and body mass index) did not correlate with the amount of material loss observed (p > 0.078). Bilaterally revised implants showed higher amounts of combined total material loss and similar wear patterns on both sides. The consistent wear pattern found in this study has not been reported previously, suggesting that the device design and materials are associated with the failure of this prosthesis. PMID:26430009

  16. Are Western Knee Designs Dimensionally Correct for Korean Women? A Morphometric Study of Resected Femoral Surfaces during Primary Total Knee Arthroplasty

    PubMed Central

    Lyu, Suk-Joo; Kang, Hyung Wook

    2016-01-01

    Background The purpose of this study was to determine the shape of the distal femur of Korean women compared with the prostheses currently available in Korea. Methods Morphometric data (5 parameters) were measured in 356 resected femurs of Korean women undergoing primary total knee arthroplasty (TKA) utilizing the LCS knee implant (DePuy). The data were then compared with 5 additional contemporary TKA implant systems. Results Implant designs based on Caucasian population data do not ideally match the distal femoral morphology of Korean women. Overhang at the anterior mediolateral width was observed in 84.8% for the LCS while a gender-specific implant resulted in undercoverage of the bone in 86%. Posterior overhang was observed in up to 51.2%. Most implant designs have a narrower intercondylar notch than the morphologic data of Korean women. Conclusions Since there is some difference between the shape of distal femur of Korean women and that of the implants, surgeons should have this in mind when selecting an implant for a patient. These data may also be used as a guideline for future prosthetic design options for Korean women population. PMID:27583107

  17. Radiographic and scintigraphic evaluation of total knee arthroplasty

    SciTech Connect

    Schneider, R.; Soudry, M.

    1986-04-01

    Various radiographic and scintigraphic methods are used to supplement clinical findings in the evaluation of total knee arthroplasty and its complications. Serial roentgenograms offer reliable information for diagnosing mechanical loosening. Wide and extensive radiolucency at the cement-bone interface and shift in position and alignment of prosthetic components can be seen in almost all cases by the time revision is necessary. Radiographic abnormalities are usually not present in acute infection, but are often present in chronic infection. Bone scanning has a high sensitivity for diagnosis of infection or loosening, but is nonspecific because increased uptake is often present around asymptomatic total knee arthroplasties with normal radiographs. Differential bone and Gallium scanning and scanning with Indium 111-labeled leukocytes have a greater specificity for diagnosis of infection than does bone or Gallium scanning alone. Routine radiographic and scintigraphic studies have shown a high incidence of deep vein thrombosis in the calf after total knee arthroplasty. Clinically significant pulmonary embolization is infrequent.

  18. Preliminary Study of a Hybrid Helicon-ECR Plasma Source

    NASA Astrophysics Data System (ADS)

    M. Hala, A.; Oksuz, L.; Ximing, Zhu

    2016-08-01

    A new type of hybrid discharge is experimentally investigated in this work. A helicon source and an electron cyclotron resonance (ECR) source were combined to produce plasma. As a preliminary study of this type of plasma, the optical emission spectroscopy (OES) method was used to obtain values of electron temperature and density under a series of typical conditions. Generally, it was observed that the electron temperature decreases and the electron density increases as the pressure increased. When increasing the applied power at a certain pressure, the average electron density at certain positions in the discharge does not increase significantly possibly due to the high degree of neutral depletion. Electron temperature increased with power in the hybrid mode. Possible mechanisms of these preliminary observations are discussed.

  19. Tree STEM Reconstruction Using Vertical Fisheye Images: a Preliminary Study

    NASA Astrophysics Data System (ADS)

    Berveglieri, A.; Tommaselli, A. M. G.

    2016-06-01

    A preliminary study was conducted to assess a tree stem reconstruction technique with panoramic images taken with fisheye lenses. The concept is similar to the Structure from Motion (SfM) technique, but the acquisition and data preparation rely on fisheye cameras to generate a vertical image sequence with height variations of the camera station. Each vertical image is rectified to four vertical planes, producing horizontal lateral views. The stems in the lateral view are rectified to the same scale in the image sequence to facilitate image matching. Using bundle adjustment, the stems are reconstructed, enabling later measurement and extraction of several attributes. The 3D reconstruction was performed with the proposed technique and compared with SfM. The preliminary results showed that the stems were correctly reconstructed by using the lateral virtual images generated from the vertical fisheye images and with the advantage of using fewer images and taken from one single station.

  20. Preliminary Study of a Piston Pump for Cryogenic Fluids

    NASA Technical Reports Server (NTRS)

    Biermann, Arnold E.; Kohl, Robert C.

    1959-01-01

    Preliminary data are presented covering the performance of a low-speed, five-cylinder piston pump designed for handling boiling hydrogen. This pump was designed for a flow of 55 gallons per minute at 240 rpm with a discharge pressure of 135 pounds per square inch. Tests were made using JP-4 fuel, liquid nitrogen, and liquid hydrogen. Pump delivery and endurance characteristics were satisfactory for the range of operation covered. In connection with the foregoing pump development, the cavitation characteristics of a preliminary visual model, glass-cylinder pump and of a simple reciprocating disk were studied. Subcooling of approximately 0.60 F was obtained from the cavitation produced by reciprocating a disk in boiling nitrogen and in boiling water. The subcooling obtained in a similar manner with liquid hydrogen was somewhat less.

  1. Increased Long-Term Cardiovascular Risk After Total Hip Arthroplasty

    PubMed Central

    Gordon, Max; Rysinska, Agata; Garland, Anne; Rolfson, Ola; Aspberg, Sara; Eisler, Thomas; Garellick, Göran; Stark, André; Hailer, Nils P.; Sköldenberg, Olof

    2016-01-01

    Abstract Total hip arthroplasty is a common and important treatment for osteoarthritis patients. Long-term cardiovascular effects elicited by osteoarthritis or the implant itself remain unknown. The purpose of the present study was to determine if there is an increased risk of late cardiovascular mortality and morbidity after total hip arthroplasty surgery. A nationwide matched cohort study with data on 91,527 osteoarthritis patients operated on, obtained from the Swedish Hip Arthroplasty Register. A control cohort (n = 270,688) from the general Swedish population was matched 1:3 to each case by sex, age, and residence. Mean follow-up time was 10 years (range, 7–21). The exposure was presence of a hip replacement for more than 5 years. The primary outcome was cardiovascular mortality after 5 years. Secondary outcomes were total mortality and re-admissions due to cardiovascular events. During the first 5 to 9 years, the arthroplasty cohort had a lower cardiovascular mortality risk compared with the control cohort. However, the risk in the arthroplasty cohort increased over time and was higher than in controls after 8.8 years (95% confidence interval [CI] 7.0–10.5). Between 9 and 13 years postoperatively, the hazard ratio was 1.11 (95% CI 1.05–1.17). Arthroplasty patients were also more frequently admitted to hospital for cardiovascular reasons compared with controls, with a rate ratio of 1.08 (95% CI 1.06–1.11). Patients with surgically treated osteoarthritis of the hip have an increased risk of cardiovascular morbidity and mortality many years after the operation when compared with controls. PMID:26871792

  2. Alternative bearings in total hip arthroplasty in the young patient.

    PubMed

    Kamath, Atul F; Prieto, Hernan; Lewallen, David G

    2013-10-01

    Total hip arthroplasty is an effective treatment option for advanced hip arthritis in elderly patients. Studies in young patients have traditionally shown less durable results. With current implants, surgical technique, and cementless fixation methods, the durability of total hip arthroplasty may now be related to the wear performance of the bearing surfaces. To improve implant longevity, there are several bearing surface choices currently available for this demanding group of patients. Alternatives must be evaluated in terms of the risks and benefits associated with each articulation, and all new technologies must be carefully monitored over the long term. PMID:24095062

  3. Oxidized Zirconium Bearing Surfaces in Total Knee Arthroplasty: Lessons Learned.

    PubMed

    Schüttler, Karl Friedrich; Efe, Turgay; Heyse, Thomas J; Haas, Steven B

    2015-10-01

    Polyethylene wear in total knee arthroplasty is a still unsolved problem resulting in osteolysis and long-term failure of knee joint replacement. To address the problem of polyethylene wear, research aimed for an optimal implant design and for an optimal combination of bearing surfaces. Oxidized zirconium was introduced to minimize surface wear and thus potentially increase long-term implant survival. This review comprises the current literature related to in vitro and in vivo studies evaluating performance of oxidized zirconium total knee arthroplasty and results from retrieval analyses. PMID:26216647

  4. Oxidized Zirconium Bearing Surfaces in Total Knee Arthroplasty: Lessons Learned.

    PubMed

    Schüttler, Karl Friedrich; Efe, Turgay; Heyse, Thomas J; Haas, Steven B

    2015-10-01

    Polyethylene wear in total knee arthroplasty is a still unsolved problem resulting in osteolysis and long-term failure of knee joint replacement. To address the problem of polyethylene wear, research aimed for an optimal implant design and for an optimal combination of bearing surfaces. Oxidized zirconium was introduced to minimize surface wear and thus potentially increase long-term implant survival. This review comprises the current literature related to in vitro and in vivo studies evaluating performance of oxidized zirconium total knee arthroplasty and results from retrieval analyses.

  5. Predicting poor physical performance after total knee arthroplasty.

    PubMed

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

    2012-11-01

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

  6. Predicting Poor Physical Performance after Total Knee Arthroplasty

    PubMed Central

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

    2012-01-01

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

  7. Does Prior Shoulder Surgery Negatively Impact Shoulder Arthroplasty Outcomes?

    PubMed Central

    Frank, Rachel M.; Aiyash, Sal; Kupfer, Noam; Tilton, Annemarie K.; Cole, Brian J.; Verma, Nikhil N.; Nicholson, Gregory P.; Romeo, Anthony A.

    2015-01-01

    Objectives: Several studies have shown a negative correlation between prior knee arthroscopy and ultimate knee arthroplasty outcomes compared to patients without prior arthroscopy. The purpose of this study was to determine the effects of prior shoulder surgery on patients undergoing total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (rTSA) compared to patients without prior shoulder surgery. Methods: A retrospective review of prospectively collected data was performed on 107 patients undergoing TSA or rTSA. All medical records were analyzed for demographic variables, type of prior shoulder surgery, and type of arthroplasty. All patients underwent a clinical follow-up evaluation, and were evaluated with the American Shoulder and Elbow Society (ASES), Simple Shoulder Test (SST), and Visual Analog Scale (VAS) outcomes scores. Complications, failures, and reoperations were also recorded an analyzed. Results: A total of 107 patients (47 males, 60 females) were included with an average follow-up of 24 months (minimum 12 months). Seventy-one patients (underwent arthroplasty without prior surgery (30 rTSA, 41 TSA) while 50 patients underwent arthroplasty with a history of at least one prior shoulder surgery (27 rTSA, 9 TSA). Prior surgeries included a mix of both open and arthroscopic procedures, including open and arthroscopic rotator cuff repair, open and arthroscopic stabilization (with and without bone augmentation), arthroscopic capsular release, and arthroscopic debridement. Following arthroplasty, both groups experienced significant improvements in ASES, SST, and VAS scores compared to preoperative scores (P<0.05 for all). There was a statistically significant difference in postoperative ASES scores in the no-surgery group compared to the prior-surgery group (84.49 versus 71.67, P=0.0003) as well as in the SST scores (8.97 versus 5.47, P<0.0001); there were no differences in the VAS score (0.83 vs 1.40, P=0.104). Conclusion: Shoulder

  8. Photodynamic therapy of port wine stain: preliminary clinical studies

    NASA Astrophysics Data System (ADS)

    Nelson, J. Stuart

    1993-07-01

    The broad, long term objective of this work is the development of Photodynamic Therapy (PDT) for application in the clinical management of patients with port wine stain (PWS). PDT involves the use of an exogenous drug which is concentrated in a targeted tissue. When irradiated at wavelengths specifically absorbed by the drug, selective destruction of the targeted tissue, without the production of heat, occurs. The results of this preliminary study demonstrate in human PWS patients that a photosensitizer, such as PHOTOFRINR, activated by red light at the appropriate therapeutic wavelength, can cause destruction of subsurface blood vessels in the skin with a high degree of specificity, and further study appears warranted.

  9. Assessment of abilities in basketball: a preliminary study.

    PubMed

    Derri, V; Kioumourtzoglou, E; Tzetzis, G

    1998-08-01

    Understanding the responding at two competitive levels of sports is prerequisite for successful identification and selection of the best athletes. The present study is a preliminary report about scores on 17 cognitive, perceptual, motor, and psychological measures of 13 elite Greek basketball athletes (national team), 20 to 22 years of age, and 15 children on a national basketball team and 14 to 15 years of age. Longitudinal studies must be conducted for the identification of the relationships among these measures and basketball performance and the development of a model for selection of athletes.

  10. Analysis and evaluation of a biomedical polycarbonate urethane tested in an in vitro study and an ovine arthroplasty model. Part II: in vivo investigation.

    PubMed

    Khan, Imran; Smith, Nigel; Jones, Eric; Finch, Dudley S; Cameron, Ruth Elizabeth

    2005-02-01

    The polyurethane (PU) elastomer Corethane 80A (Corvita) is being considered as the acetabular bearing material in a novel total replacement hip joint. Its biostability was investigated in vitro (Analysis and evaluation of a biomedical polycarbonate urethane tested in an in vitro study and an ovine arthroplasty model. Part I: material selection and evaluation, Biomaterials, in press) together with three other commercially available biomedical PUs: Pellethane 2363-80A (DOW Chemical), a polyhexamethylene oxide based PU, PHMO-PU (CSIRO, not supplied as a commercial product) and ChronoFlex AL-80A (CardioTech). From the in vitro studies, Corethane 80A displayed the best overall resistance to hydrolysis, ESC, MIO and calcification, followed by ChronoFlex 80A and PHMO-PU, with Pellethane 80A being the least stable. Building on the in vitro investigation, the follow-up in vivo study (reported here) assessed Corethane 80A as the bearing layer in a prototype compliant layer acetabular cup, in a fully functioning ovine total hip arthoplasty (THA) model. PU degradation in the retrieved cups was analysed using a range of analytical and physical-testing methods including mechanical testing, differential scanning calorimetry, Fourier transform infrared spectroscopy and environmental scanning electron microscopy. The Corethane 80A functioned well in the THA model, with the bearing surfaces of the retrieved hip cups showing no significant evidence of biodegradation or wear damage after 3 years in vivo. The findings in this study provide compelling evidence for the biostability and effectiveness of acetabular cups incorporating a Corethane 80A compliant bearing layer. PMID:15282141

  11. Analysis and evaluation of a biomedical polycarbonate urethane tested in an in vitro study and an ovine arthroplasty model. Part II: in vivo investigation.

    PubMed

    Khan, Imran; Smith, Nigel; Jones, Eric; Finch, Dudley S; Cameron, Ruth Elizabeth

    2005-02-01

    The polyurethane (PU) elastomer Corethane 80A (Corvita) is being considered as the acetabular bearing material in a novel total replacement hip joint. Its biostability was investigated in vitro (Analysis and evaluation of a biomedical polycarbonate urethane tested in an in vitro study and an ovine arthroplasty model. Part I: material selection and evaluation, Biomaterials, in press) together with three other commercially available biomedical PUs: Pellethane 2363-80A (DOW Chemical), a polyhexamethylene oxide based PU, PHMO-PU (CSIRO, not supplied as a commercial product) and ChronoFlex AL-80A (CardioTech). From the in vitro studies, Corethane 80A displayed the best overall resistance to hydrolysis, ESC, MIO and calcification, followed by ChronoFlex 80A and PHMO-PU, with Pellethane 80A being the least stable. Building on the in vitro investigation, the follow-up in vivo study (reported here) assessed Corethane 80A as the bearing layer in a prototype compliant layer acetabular cup, in a fully functioning ovine total hip arthoplasty (THA) model. PU degradation in the retrieved cups was analysed using a range of analytical and physical-testing methods including mechanical testing, differential scanning calorimetry, Fourier transform infrared spectroscopy and environmental scanning electron microscopy. The Corethane 80A functioned well in the THA model, with the bearing surfaces of the retrieved hip cups showing no significant evidence of biodegradation or wear damage after 3 years in vivo. The findings in this study provide compelling evidence for the biostability and effectiveness of acetabular cups incorporating a Corethane 80A compliant bearing layer.

  12. Rheumatoid arthritis is associated with higher 90-day Hospital Readmission Rates Compared to Osteoarthritis after Hip or Knee arthroplasty: A cohort study

    PubMed Central

    Singh, Jasvinder A.; Inacio, Maria C.S.; Namba, Robert S.; Paxton, Elizabeth W.

    2014-01-01

    Objective To examine if an underlying diagnosis of rheumatoid arthritis (RA) or osteoarthritis (OA) impacts the 90-day readmission rates after total hip or knee arthroplasty (THA or TKA). Methods Prospectively collected data from an integrated healthcare system Total Joint Replacement Registry of adults with RA or OA undergoing unilateral primary THA or TKA during 2009-2011 were analyzed. Adjusted logistic regression models for 90-day readmission were fit. Odds ratios with 95% confidence intervals (CI) were calculated. Study year was an effect modifier for the outcome, therefore separate analyses were conducted for each of the three study years. Results Of the 34,311 patients, 496 had RA and 33,815 had OA. Comparing RA and OA, there were: 73% and 61% women; 45% and 70% Caucasians; and the mean age was lower, 61 vs. 67 years (p<0.001). Respective crude 90-day readmission rates were 8.5% and 6.7%. The adjusted odds of 90-day readmission increased from year to year for RA compared to OA patients, from 0.89 (95% CI, 0.46-1.71) in 2009 to 1.34 (95% CI, 0.69-2.61) in 2010 to 1.74 (95% CI, 1.16-2.60) in 2011. The two most common readmission reasons were: joint prosthesis infection (10.2%) and septicemia (10.2%) in RA; joint prosthesis infection (5.7%) and other postoperative infection (5.1%) in OA. Conclusions RA is a risk factor for 90-day readmission after primary TKA or THA. An increasing risk of readmissions noted in RA in 2011 is concerning and indicates further studies should examine the reasons for this increasing trend. PMID:25302697

  13. The association between component malalignment and post-operative pain following navigation-assisted total knee arthroplasty: results of a cohort/nested case-control study.

    PubMed

    Czurda, Thomas; Fennema, Peter; Baumgartner, Martin; Ritschl, Peter

    2010-07-01

    Previous studies have noted an adverse relationship between implant malalignment during total knee arthroplasty (TKA) and post-operative pain. Although some evidence exists indicating that computer-assisted surgical navigation for TKA can improve the accuracy of component alignment, its impact on clinical outcomes is currently unknown. The dual goals of the present cohort/nested case-control study were to (1) compare self-reported responses to the Western Ontario-McMaster Osteoarthritis Index (WOMAC) questionnaire between computer-assisted TKA (123 patients) using the imageless PiGalileo navigation system and conventional TKA (207 patients) [cohort analysis], and (2) to investigate a potential association between malalignment and post-operative pain in 19 painful knees and 19 asymptomatic knees obtained from the cohort analysis using matched sampling [nested case-control study]. In the cohort analysis, a relevant but non-significant (P = 0.06) difference in the occurrence of chronic pain was observed between the navigated (12%) and conventional arms (20%). Median post-operative WOMAC pain score was 100 (range, 50-100) in the conventional group and 100 (range, 65-100) in the navigated group. However, the Mann-Whitney test revealed a significant difference in favor of the navigated group (P = 0.01). In the nested case-control analysis, radiological outcomes and computer tomography (CT) measurements of femoral rotation were compared between the groups. The CT rotation measurements yielded evidence of a relationship between post-operative pain and incorrect rotational alignment of the femoral component of more than 3 degrees (OR: 7; 95% CI: 1.2-42; P = .033). In conclusion, there was no clinical benefit to computer-assisted navigation; however, a statistically significant relationship was observed between incorrect rotational alignment of the femoral component and symptoms of post-operative pain following TKA.

  14. Changes in Intra-pelvic Obliquity Angle 0–2 Years After Total Hip Arthroplasty and Its Effects on Leg Length Discrepancy: A Retrospective Study

    PubMed Central

    Zhang, Yin; Cheng, Tao; Zhang, Xian-Long

    2015-01-01

    Background: Total hip arthroplasty (THA) is one of the most effective treatments for phase III and IV hip arthrosis. Lower limb length balancing is one of the determining factors of a successful surgery, particularly in patients with developmental dysplasia of the hip (DDH). The purpose of this study was to evaluate the postoperative change in intra-pelvic obliquity (intra-PO) angle in the coronal plane and its effects on leg length discrepancy (LLD) within 2 years. Methods: A total of 78 patients (70 females, 8 males) were enrolled in this study. All patients were suffering from DDH with varying degrees of LLD. Pelvic plain radiographs were collected before and after the operation. The intra-PO angles were measured 0, 0.5, 1 and 2 years after THA. At the same time, postoperative LLD was measured with blocking test. Results: PO changed significantly in the first year after THA surgery (0 year vs. 0.5 year, P < 0.01; 0.5 year vs. 1 year, P < 0.01), and the changing value of intra-PO angle (ΔPO) slowed down substantially during the first 2 years after THA (0.5 year vs. 0.5–1 year, P < 0.01; 0.5–1 year vs. 1–2 years, P < 0.01). With the change in intra-PO angle, LLD also got narrow within the 1st year (0 year vs. 0.5 year, P < 0.01; 0.5 year vs. 1 year, P < 0.01). Elderly patients had a smaller intra-PO angle reduction (Group A vs. Group B, P = 0.01; Group B vs. Group C, P < 0.01). Conclusions: Intra-PO angle and LLD gap narrowed with time after THA surgery. In particular, elderly patients had smaller change in intra-PO angle. PMID:25963356

  15. Revision Total Hip Arthroplasty Using Tantalum Augment in Patients with Paprosky III or IV Acetabular Bone Defects: A Minimum 2-year Follow Up Study

    PubMed Central

    Jeong, Min; Kim, Hyung-Joo; Lim, Seung-Jae; Moon, Young-Wan

    2016-01-01

    Purpose The purpose of this study is to report the short-term outcomes of revision total hip arthroplasty (THA) using tantalum augments in patients with severe acetabular bone defects. Materials and Methods We retrospectively analyzed 15 revision THAs performed in 15 patients using tantalum augments between June 2010 and December 2013. Acetabular bone defects were Paprosky type IIIA in 7 hips, type IIIB in 7, and type IV in 1. The causes of revision surgery were aseptic loosening in 12 hips and deep infection in 3. Revisions were first in 1 hip, second in 3, and third in 11. Six patients were male and 9 female with a mean age of 59 years (range, 48-75 years). Mean follow-up was 29 months (range, 24-48 months). Results Mean Harris hip score was improved from 34 points (range, 12-54 points) preoperatively to 84 points (range, 38-90 points) at final follow-up. On the final follow-up radiographs, there were 12 hips (80.0%) with stable fixation of the acetabular cup, 2 (13.3%) with secondary stability after mild acetabular protrusion, and 1 (6.7%) with radiolucency around the acetabular cup without mechanical symptoms. Complications included one patient with acute hematogenous infection managed by surgical debridement and long-term antibiotic therapy. There were no cases with nerve palsy or dislocation during the follow-up period. Conclusion The present study showed satisfactory clinical and radiographic outcomes of revision THA using tantalum augments due to severe acetabular bone defects of Paprosky type III or IV at a minimum follow-up of 2 years. PMID:27536651

  16. Is the use of computer navigation in total knee arthroplasty improving implant positioning and function? A comparative study of 198 knees operated at a Norwegian district hospital

    PubMed Central

    2013-01-01

    Background There are few Scandinavian studies on the effect of computer assisted orthopedic surgery (CAOS) in total knee arthroplasty (TKA), compared to conventional technique (CON), and there is little information on effects in pain and function scores. This retrospective study has evaluated the effects of CAOS on radiological parameters and pain, function and quality of life after primary TKA. Methods 198 primary TKAs were operated by one surgeon in two district hospitals; 103 CAOS and 95 CON. The groups were evaluated based on 3 months post-operative radiographs and a questionnaire containing the knee osteoarthritis outcome score (KOOS), the EQ-5D index score and a visual analogue scale (VAS) two years after surgery. Multiple linear regression method was used to investigate possible impact from exposure (CON or CAOS). Results On hip-knee-ankle radiographs, 20% of measurements were > ±3° of neutral in the CAOS group and 25% in the CON group (p = 0.37). For the femoral component, the number was 5% for CAOS and 18% for CON (p < 0.01). For the tibial component, the difference was not statistically significant (p = 0.58). In the sagittal plane, the surgeon tended to apply more femoral flexion and more posterior tibial slope with CAOS. We observed no statistically or clinically significant difference in KOOS score, VAS or ∆EQ-5D (all p values >0.05), but there was a trend towards better scores for CAOS. Operation time was 3 minutes longer for CON (p = 0.37). Conclusions CAOS can improve radiological measurements in primary TKA, and makes it possible to adjust component placement to the patient’s anatomy. Over-all, the two methods are equal in pain, function and quality-of-life scores. PMID:24228727

  17. Total Hip Arthroplasty Using Modular Trabecular Metal Acetabular Components for Failed Treatment of Acetabular Fractures: A Mid-term Follow-up Study

    PubMed Central

    Huang, De-Yong; Zhang, Liang; Zhou, Yi-Xin; Zhang, Chun-Yu; Xu, Hui; Huang, Yong

    2016-01-01

    Background: Porous-coated cups have been widely used in acetabular reconstruction after failed treatment of acetabular fractures, and good results have been reported with the use of these cups; however, the durability and functionality of modular trabecular metal (TM) acetabular components in acetabular reconstruction after failed treatment of acetabular fractures remain unclear. This study aimed to examine the radiographic and clinical outcomes associated with the use of modular TM acetabular components for failed treatment of acetabular fractures to assess the durability and functionality of these components in acetabular reconstruction after failed treatment of acetabular fractures. Methods: A total of 41 patients (41 hips) underwent total hip arthroplasty (THA) using modular TM acetabular components for failed treatment of acetabular fractures at our hospital between January 2007 and December 2012. Among these patients, two were lost to follow-up. Therefore, 39 patients (39 hips) were finally included in this study. The Harris hip score before and after the surgery, satisfaction level of the patients, and radiographic results were assessed. Results: The mean Harris hip score increased from 34 (range, 8–52) before surgery to 91 (range, 22–100) at the latest follow-up examination (P < 0.001). The results were excellent for 28 hips, good for six, fair for three, and poor for two. Among the 39 patients, 25 (64%) and 10 (26%) were very satisfied and somewhat satisfied, respectively. All cups were found to be fully incorporated, and no evidence of cup migration or periacetabular osteolysis was noted. Conclusions: Despite the technically demanding nature of the procedure, THA using modular TM acetabular components showed good durability and functionality and may be an effective reconstruction option for failed treatment of acetabular fractures. PMID:27064033

  18. Energy efficient engine: Preliminary design and integration studies

    NASA Technical Reports Server (NTRS)

    Johnston, R. P.; Hirschkron, R.; Koch, C. C.; Neitzel, R. E.; Vinson, P. W.

    1978-01-01

    Parametric design and mission evaluations of advanced turbofan configurations were conducted for future transport aircraft application. Economics, environmental suitability and fuel efficiency were investigated and compared with goals set by NASA. Of the candidate engines which included mixed- and separate-flow, direct-drive and geared configurations, an advanced mixed-flow direct-drive configuration was selected for further design and evaluation. All goals were judged to have been met except the acoustic goal. Also conducted was a performance risk analysis and a preliminary aerodynamic design of the 10 stage 23:1 pressure ratio compressor used in the study engines.

  19. Biocontamination Control for Spacesuit Garments - A Preliminary Study

    NASA Technical Reports Server (NTRS)

    Rhodes, Richard A.; Orndoff, Evelyne; Korona, F. Adam; Poritz, Darwin; Smith, Jelanie; Wong, Wing

    2011-01-01

    This paper outlines a preliminary study that was conducted to review, test, and improve on current space suit biocontamination control. Biocontamination from crew members can cause space suit damage and objectionable odors and lead to crew member health hazards. An understanding of the level of biocontamination is necessary to mitigate its effects. A series of tests were conducted with the intent of evaluating current suit materials, ground and on-orbit disinfectants, and potential commercial off-the-shelf antimicrobial materials. Included in this paper is a discussion of the test methodology, results, and analysis method.

  20. Experimental Studies of Ion Beam Neutralization: Preliminary Results

    SciTech Connect

    Ding, N.; Polansky, J.; Downey, R.; Wang, J.

    2011-05-20

    A testing platform is designed to study ion beam neutralization in the mesothermal, collisionless region. In the experimental setup, argon neutrals were ionized in a microwave cavity and accelerated by a plasma lens system which was biased to 2500 V above the system ground. Electrons were boiled off from two hot tungsten filaments to neutralize the ion beam. The plasma is diagnosed using Langmuir probe and Faraday probe. A 3-D traversing system and a complete data acquisition loop were developed to efficiently measure 3-D beam profile. Preliminary measurements of beam profiles are presented for different operating conditions.

  1. Effects of a Foot Pump on the Incidence of Deep Vein Thrombosis After Total Knee Arthroplasty in Patients Given Edoxaban: A Randomized Controlled Study.

    PubMed

    Sakai, Tatsuya; Izumi, Masahiro; Kumagai, Kenji; Kidera, Kenichi; Yamaguchi, Takayuki; Asahara, Tomohiko; Kozuru, Hideko; Jiuchi, Yuka; Mawatari, Masaaki; Osaki, Makoto; Motokawa, Satoru; Migita, Kiyoshi

    2016-01-01

    We conducted a randomized clinical trial to compare the effectiveness of the A-V Impulse System foot pump for reducing the incidence of deep-vein thrombosis (DVT) after total knee arthroplasty (TKA) in patients under edoxaban thromboprophylaxis. Patients undergoing primary TKA at our institution between September 2013 and March 2015 were enrolled after obtaining informed consent. The patients were randomized to use the foot pump (n = 58) and not to use the foot pump (n = 62). Both groups were given prophylactic edoxaban. Primary outcomes were any DVT as detected by bilateral ultrasonography up to postoperative day 10 (POD10) and pulmonary embolism (PE) up to POD28. The safety outcomes were bleeding and death of any cause up to POD28. Plasma D-dimer levels were measured before TKA and on POD10 after TKA. Immunoglobulin G (IgG)-class anti-PF4/heparin antibodies were measured using an IgG-specific enzyme-linked immunosorbent assay. The incidences of any DVT up to POD28 were 31.0% and 17.7% in patients with or without the foot pump, respectively. The incidences of major bleeding up to POD28 were 5.1% and 4.8% in patients with or without the foot pump, respectively. Foot pump use did not significantly reduce the incidence of DVTs in patients undergoing TKA under edoxaban thromboprophylaxis. Although seroconversion of anti-PF4/heparin antibodies was confirmed in one-fourth of patients, the seroconversion rates did not differ between patients with (20.7%) or without (25.8%) foot pump use. This study shows that the A-V Impulse system foot pump did not affect the incidence of DVT under edoxaban thromboprophylaxis in patients undergoing TKA. Seroconversion of anti-PF4/heparin antibodies was detected in a significant number of patients who underwent TKA under antithrombotic prophylaxis using edoxaban. PMID:26735531

  2. Preliminary design study of advanced multistage axial flow core compressors

    NASA Technical Reports Server (NTRS)

    Wisler, D. C.; Koch, C. C.; Smith, L. H., Jr.

    1977-01-01

    A preliminary design study was conducted to identify an advanced core compressor for use in new high-bypass-ratio turbofan engines to be introduced into commercial service in the 1980's. An evaluation of anticipated compressor and related component 1985 state-of-the-art technology was conducted. A parametric screening study covering a large number of compressor designs was conducted to determine the influence of the major compressor design features on efficiency, weight, cost, blade life, aircraft direct operating cost, and fuel usage. The trends observed in the parametric screening study were used to develop three high-efficiency, high-economic-payoff compressor designs. These three compressors were studied in greater detail to better evaluate their aerodynamic and mechanical feasibility.

  3. R&D Requirements, RF Gun Mode Studies, FEL-2 Steady-StateStudies, Preliminary FEL-1 Time-Dependent Studies, and Preliminary LayoutOption Investigation

    SciTech Connect

    Byrd, John; Corlett, John; Doolittle, Larry; Fawley, William; Lidia, Steven; Penn, Gregory; Ratti, Alex; Staples, John; Wilcox Russell; Wurtele, Jonathan; Zholents, Alexander

    2005-10-01

    This report constitutes the third deliverable of LBNLs contracted role in the FERMI {at} Elettra Technical Optimization study. It describes proposed R&D activities for the baseline design of the Technical Optimization Study, initial studies of the RF gun mode-coupling and potential effects on beam dynamics, steady-state studies of FEL-2 performance to 10 nm, preliminary studies of time-dependent FEL-1 performance using electron bunch distribution from the start-to-end studies, and a preliminary investigation of a configuration with FEL sinclined at a small angle from the line of the linac.

  4. Preliminary paleomagnetic study of the Thetford Mines Ordovician Ophiolite (Canada)

    NASA Astrophysics Data System (ADS)

    Di Chiara, Anita; Morris, Antony; Anderson, Mark

    2016-04-01

    Extension associated with oceanic ridges at divergent plate boundaries is characterized by normal faulting and episodic magma supply. Studies in modern oceanic settings suggest locally along ridges both lower crust and upper mantle peridotites may be exhumed to the seafloor in features known as oceanic core complexes (OCC). OCC are characterized by long-lived low-angle detachment faults that extend for 10s of km, and that are crosscut by high-angle normal faults oriented parallel to the rift axis. Here we present preliminary results from 12 paleomagnetic sites sampled on an example of fossilized Ordovician OCC preserved in the in the Canadian Appalachians, the Southern Quebec ophiolites. These were obducted and subjected to polyphase deformation during Palaeozoic orogeny along the Laurentian margin of Iapetus. Although locally obscured by tectonic fabrics and structures, the original relationships between the ophiolitic mantle, the overlying plutonic section, and onlapping Ordovician siliciclastic rocks can be reconstructed within the Thetford-Mines ophiolite. Preliminary results from AMS and Thermal demagnetization experiments record a remarkably consistent overprint from the youngest (Acadian) phase of Paleozoic orogeny. Although complicating further study of intra-oceanic deformation along the detachment fault in the original OCC, the results provide further insights into the progressive overprint of deformation events as recorded by AMS.

  5. Crying abnormalities in congenital hypothyroidism: preliminary spectrographic study.

    PubMed

    Boero, D L; Weber, G; Vigone, M C; Lenti, C

    2000-09-01

    The aim of this preliminary study was to evaluate the acoustic patterns of the cries of hypothyroid newborns at the time of diagnosis and after the beginning of therapy. Cries were recorded at the nursery of the San Raffaele Hospital, Milan, Italy from 12 full-term subjects (three boys and nine girls) affected by congenital hypothyroidism. Results show that untreated hypothyroid infants at first recording had fewer voiceless and partially voiced cries than normal controls. The percent distribution of this pattern did not change at the second recording after the onset of substitutive therapy. Also, untreated hypothyroid infants had many more cry units showing a vibrato contour than did controls, and this pattern did not change after the onset of treatment. Starting, maximum, minimum, and end frequencies measured on the fundamental were significantly lower in the hypothyroid sample. Four hypothyroid subjects recorded before therapy and within 4 weeks after therapy onset significantly augmented their fundamental frequency parameters; however, in 25% of the sample, sound parameters remained unaltered after 3 or more weeks of treatment. To our knowledge the present preliminary study is the first one performed on follow-up of hypothyroid newborns and indicates that both central and peripheral damage might influence the pattern of crying in untreated hypothyroid infants. PMID:11019791

  6. Nevada potential repository preliminary transportation strategy Study 2. Volume 1

    SciTech Connect

    1996-02-01

    The objectives of this study were to build on the findings of the Nevada Potential Repository Preliminary Transportation Strategy Study 1 (CRWMS M&O 1995b), and to provide additional information for input to the repository environmental impact statement (EIS) process. In addition, this study supported the future selection of a preferred rail corridor and/or heavy haul route based on defensible data, methods, and analyses. Study research did not consider proposed legislation. Planning was conducted according to the Civilian Radioactive Waste Management Program Plan (DOE 1994a). The specific objectives of Study 2 were to: eliminate or reduce data gaps, inconsistencies, and uncertainties, and strengthen the analysis performed in Study 1; develop a preliminary list of rail route evaluation criteria that could be used to solicit input from stakeholders during scoping meetings. The evaluation criteria will be revised based on comments received during scoping; restrict and refine the width of the four rail corridors identified in Study 1 to five miles or less, based on land use constraints and engineering criteria identified and established in Study 2; evaluate national-level effects of routing spent nuclear fuel and high-level waste to the four identified branch lines, including the effects of routing through or avoiding Las Vegas; continue to gather published land use information and environmental data to support the repository EIS; continue to evaluate heavy haul truck transport over three existing routes as an alternative to rail and provide sufficient information to support the repository EIS process; and evaluate secondary uses for rail (passenger use, repository construction, shared use).

  7. Duloxetine in OsteoArthritis (DOA) study: study protocol of a pragmatic open-label randomised controlled trial assessing the effect of preoperative pain treatment on postoperative outcome after total hip or knee arthroplasty

    PubMed Central

    Blikman, T; Rienstra, W; van Raaij, T M; ten Hagen, A J; Dijkstra, B; Zijlstra, W P; Bulstra, S K; van den Akker-Scheek, I; Stevens, M

    2016-01-01

    Introduction Residual pain is a major factor in patient dissatisfaction following total hip arthroplasty or total knee arthroplasty (THA/TKA). The proportion of patients with unfavourable long-term residual pain is high, ranging from 7% to 34%. There are studies indicating that a preoperative degree of central sensitisation (CS) is associated with poorer postoperative outcomes and residual pain. It is thus hypothesised that preoperative treatment of CS could enhance postoperative outcomes. Duloxetine has been shown to be effective for several chronic pain syndromes, including knee osteoarthritis (OA), in which CS is most likely one of the underlying pain mechanisms. This study aims to evaluate the postoperative effects of preoperative screening and targeted duloxetine treatment of CS on residual pain compared with care-as-usual. Methods and analysis This multicentre, pragmatic, prospective, open-label, randomised controlled trial includes patients with idiopathic hip/knee OA who are on a waiting list for primary THA/TKA. Patients at risk for CS will be randomly allocated to the preoperative duloxetine treatment programme group or the care-as-usual control group. The primary end point is the degree of postoperative pain 6 months after THA/TKA. Secondary end points at multiple time points up to 12 months postoperatively are: pain, neuropathic pain-like symptoms, (pain) sensitisation, pain catastrophising, joint-associated problems, physical activity, health-related quality of life, depressive and anxiety symptoms, and perceived improvement. Data will be analysed on an intention-to-treat basis. Ethics and dissemination The study is approved by the local Medical Ethics Committee (METc 2014/087) and will be conducted according to the principles of the Declaration of Helsinki (64th, 2013) and the Good Clinical Practice standard (GCP), and in compliance with the Medical Research Involving Human Subjects Act (WMO). Trial registration number 2013-004313-41; Pre

  8. Arthroscopic management of the painful total elbow arthroplasty

    PubMed Central

    Bain, Gregory I

    2015-01-01

    Background Failure of total elbow arthroplasty is more common than after other major joint arthroplasties and is often a result of aseptic loosening, peri-prosthetic infection, fracture and instability. Infection can be a devastating complication, yet there are no established guidelines for the pre-operative diagnosis of total elbow peri-prosthetic infection. This is because pre-operative clinical, radiographic and biochemical tests are often unreliable. Methods Using three case examples, a standardized protocol for the clinical and arthroscopic assessment of the painful total elbow arthroplasty is described. This is used to provide a mechanical and microbiological diagnosis of the patient’s pain. Results There have been no complications resulting from the use of this technique in the three patients described, nor in any other patient to date. Conclusions The staged protocol described in the present study, utilizing arthroscopic assessment, has refined the approach to the painful total elbow arthroplasty because it directly influences the definitive surgical management of the patient. It is recommended that other surgeons follow the principles outlined in the present study when faced with this challenging problem. PMID:27583000

  9. Wear simulation strategies for reverse shoulder arthroplasty implants.

    PubMed

    Langohr, G Daniel G; Athwal, George S; Johnson, James A; Medley, John B

    2016-05-01

    Reverse total shoulder arthroplasty is a clinically accepted surgical procedure; however, its long-term wear performance is not known. The purpose of this work is to review wear simulator testing of reverse total shoulder arthroplasty, to develop a wear simulator protocol for reverse total shoulder arthroplasty, and to test it by performing a pilot study. The review of wear simulator testing in the literature revealed considerable variation in protocols. A combination of our own cadaveric testing and those of other research groups helped in determining the magnitude and direction of joint loading for the development of the present protocol. A MATCO orbital-bearing simulator was adapted using custom fixtures to simulate a circumduction motion of the shoulder under mildly adverse conditions, and a pilot study gave wear rates within the wide range found in the literature. Arguments were presented in support of the currently developed protocol, but it was also suggested that, rather than rely on one protocol, a series of simulator wear protocols should be developed to fully test the implant wear performance in reverse total shoulder arthroplasty.

  10. Hip arthroplasty after treatment failure in intertrochanteric femoral fractures.

    PubMed

    Gagała, Jacek; Blacha, Jan; Twaróg, Zbigniew

    2005-10-28

    Background. Treatment failure in intertrochanteric fractures of the femur leads to pain and limitations of limb function. Methods of treatment allowing for union in order to preserve the proximal femur are undertaken in younger patients. Older patients who have poor quality bone stock and bone loss in the proximal femur are treated with hip arthroplasty. The aim of our study was to perform a long-range follow-up on patients treated with hip arthroplasty after failure of peritrochanteric fracture treatment. Material and methods. We studied 10 patients (6 men and 4 women, average age 61 years) seen after treatment failure in peritrochanteric fractures during the period 1998 - 2003 in the Orthopedics and Traumatology Departament at the Skubiszewski Medical University of Lublin. Seven patients were treated with hemiarthroplasty, and three with total hip replacement. Three long femoral stems were used. Results. One patent died in the early postoperative period. There were two dislocations of hip replacements. An increase in Harris Hip Score was noted, from an average 25 points preoperatively to an average 85 points in long-term follow-up. There was one revision arthroplasty due to breakage of the ceramic cup and head of a Mittelmeier prosthesis. Conclusions. Patients treated with hip arthroplasty after treatment failures in peritrochanteric fractures of the femur can achieve a pain-free hip and good limb function.

  11. Wear simulation strategies for reverse shoulder arthroplasty implants.

    PubMed

    Langohr, G Daniel G; Athwal, George S; Johnson, James A; Medley, John B

    2016-05-01

    Reverse total shoulder arthroplasty is a clinically accepted surgical procedure; however, its long-term wear performance is not known. The purpose of this work is to review wear simulator testing of reverse total shoulder arthroplasty, to develop a wear simulator protocol for reverse total shoulder arthroplasty, and to test it by performing a pilot study. The review of wear simulator testing in the literature revealed considerable variation in protocols. A combination of our own cadaveric testing and those of other research groups helped in determining the magnitude and direction of joint loading for the development of the present protocol. A MATCO orbital-bearing simulator was adapted using custom fixtures to simulate a circumduction motion of the shoulder under mildly adverse conditions, and a pilot study gave wear rates within the wide range found in the literature. Arguments were presented in support of the currently developed protocol, but it was also suggested that, rather than rely on one protocol, a series of simulator wear protocols should be developed to fully test the implant wear performance in reverse total shoulder arthroplasty. PMID:27160563

  12. Results of preliminary Microwave Multi-Applications Payload (MMAP) study

    NASA Technical Reports Server (NTRS)

    1975-01-01

    A preliminary feasibility study of the microwave multi-applications payload (MMAP) system for the Spacelab has been carried out. The initial objectives of this study have been to determine the minimum equipment requirements of the MMAP and the feasibility of placing the numerous large aperture antennas in the Spacelab. The study was begun by reviewing the experimental objectives and techniques and determining areas of commonality. Emphasis was given to the determination of common RF equipment requirements. These requirementers were considered after agreement among the experiments had been reached on limiting the number of frequencies to be used in the system. This was done so that the number of antennas, transmitters, and receivers could be minimized. The electronics system block diagram and the antenna configurations were considered in some details. It was concluded that the MMAP is feasible and can be an economical method of achieving a large number of experimental goals.

  13. Cementless Total Hip Arthroplasty in Hip Dysplasia with an Extensively Porous-Coated Cylindrical Stem Modified for Asians: A 12-Year Follow-Up Study.

    PubMed

    Kato, Tsutomu; Otani, Takuya; Sugiyama, Hajime; Hayama, Tetsuo; Katsumata, Souichi; Marumo, Keishi

    2015-06-01

    Long-term outcomes of primary cementless total hip arthroplasty were examined for 198 hips of Asian patients with developmental dysplasia of the hip. AML stems were modified for patients' relatively small physique. Stable fixation was achieved despite various proximal femoral deformities. At follow up (mean 12.1 years), radiographs demonstrated fixation in all hips, with 100% stem survivorship. Radiographic changes revealed that the severity of stress-shielding was mild in 55% of hips, moderate in 26%, and severe in 19%. Longer follow up is needed to determine whether these changes will develop into clinical manifestations. A distal fixation stem can be a useful reconstruction option when application of a proximal fixation stem in primary total hip arthroplasty is difficult for various reasons. PMID:25677937

  14. Footprint mismatch in lumbar total disc arthroplasty

    PubMed Central

    Michaela, Gstoettner; Denise, Heider; Liebensteiner, Michael

    2008-01-01

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

  15. Possession experiences in dissociative identity disorder: a preliminary study.

    PubMed

    Ross, Colin A

    2011-01-01

    Dissociative trance disorder, which includes possession experiences, was introduced as a provisional diagnosis requiring further study in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Consideration is now being given to including possession experiences within dissociative identity disorder (DID) in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), which is due to be published in 2013. In order to provide empirical data relevant to the relationship between DID and possession states, I analyzed data on the prevalence of trance, possession states, sleepwalking, and paranormal experiences in 3 large samples: patients with DID from North America; psychiatric outpatients from Shanghai, China; and a general population sample from Winnipeg, Canada. Trance, sleepwalking, paranormal, and possession experiences were much more common in the DID patients than in the 2 comparison samples. The study is preliminary and exploratory in nature because the samples were not matched in any way.

  16. Possession experiences in dissociative identity disorder: a preliminary study.

    PubMed

    Ross, Colin A

    2011-01-01

    Dissociative trance disorder, which includes possession experiences, was introduced as a provisional diagnosis requiring further study in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Consideration is now being given to including possession experiences within dissociative identity disorder (DID) in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), which is due to be published in 2013. In order to provide empirical data relevant to the relationship between DID and possession states, I analyzed data on the prevalence of trance, possession states, sleepwalking, and paranormal experiences in 3 large samples: patients with DID from North America; psychiatric outpatients from Shanghai, China; and a general population sample from Winnipeg, Canada. Trance, sleepwalking, paranormal, and possession experiences were much more common in the DID patients than in the 2 comparison samples. The study is preliminary and exploratory in nature because the samples were not matched in any way. PMID:21667381

  17. Recurrent laryngeal nerve histopathology in spastic dysphonia: a preliminary study.

    PubMed

    Dedo, H H; Izdebski, K; Townsend, J J

    1977-01-01

    Spastic dysphonia is a severe voice disorder ordinarily described as psychogenic. Organic-neurologic changes secondary to central or peripheral nervous system involvement have also been postulated and led recently to the surgical treatment of spastic dysphonia by unilateral section of the recurrent laryngeal nerve (RLN). This study reports the histologic findings from these resections of the RLN from patients with an average 9.5 years duration of spastic dysphonia. Thirty percent of the RLNs examined demonstrated significant abnormalities as compared to age-matched controls. Although no reactive changes were noted by light microscopy, groups of fibers which did not stain for myelin or axons were found in RLNs from patients with spastic dysphonia. A preliminary ultrastructural study of these areas in one RLN revealed sheets of unmyelinated axons. These findings suggest an organic basis for spastic dysphonia at least in some patients.

  18. Preliminary Studies for Three Experiments at Treiman-Yang Criterion

    NASA Astrophysics Data System (ADS)

    Kres, I. V.; Kondratyev, V. N.; Cherubini, S.; Spitaleri, C.

    2016-05-01

    Nuclear reactions with three bodies in their final state may proceed through different reaction mechanisms. The Feynman graph technique has been widely used to describe such reactions. However, it is very difficult in general to select the graphs that dominate in given process. The Treiman-Yang criterion is one of the most powerful experimental tests for verifying the pole approximation prediction when describing a quasi-free reaction mechanism. We propose the theoretical study of the H2(B10, α Be7)ns, H1(B11, α1α2)αs, He3(Be9, α1α2)αs reactions at different energies. The preliminary study helps to check the existence of a QF channel by using the TY creterion.

  19. Telemetric motor activity in children. A preliminary study.

    PubMed

    Foster, F G; McPartland, R J; Kupfer, D J

    1977-01-01

    A lightweight telemetric mobility sensing system was used to study the relationship between high levels of motor activity during free-play and school performance. Among the 21 normal children, there was a significant correlation between high ankle motor activity during free-play, poor school achievement, the presence of neurological soft signs, and a poor self-image. Those normals whose free-play ankle activity was above the mean, also had significantly more errors and performed at a significantly lower level on the Bender Visual Motor Gestalt Test than children whose activity was below the mean. This preliminary study suggests that the telemetric mobility sensing system can be easily applied to children to assess clinically relevant components of psychomotor activity.

  20. Preliminary study: isotopic safeguards techniques (IST) LMFBR fuel cycles

    SciTech Connect

    Persiani, P. J.; Kroc, T. K.

    1980-06-01

    This memorandum presents the preliminary results of the effort to investigate the applicability of isotope correlation techniques (ICT), formulated for the LWR system, to the LMFBR fuel cycle. The detailed isotopic compositional changes with burnup developed for the CRBR was utilized as the reference case. This differs from the usual LMFBR design studies in that the core uranium is natural uranium rather than depleted. Nevertheless, the general isotopic behavior should not differ significantly and does allow an initial insight into the expected behavior of isotopic correlations for the LMFBR power systems such as: the U.K. PFR and reprocessing plant; the French Phenix and Superphenix; and the US reference conceptual design studies (CDS) of homogeneous and heterogeneous LMFBR systems as they are developed.

  1. Assessing hospital cost of joint arthroplasty

    PubMed Central

    BONIFORTI, FILIPPO

    2015-01-01

    Purpose total joint replacement is one of the most successful procedures in medicine and cost reimbursements to hospitals for the joint arthroplasty diagnosis-related group are among the largest payments made by a Regional Health Service. Despite the popularity of these procedures, there are few high-quality cost-effectiveness studies on this topic. This study evaluates the cost of total joint arthroplasty performed in a district hospital. Methods direct and indirect costs have been measured and patient procedure pathway was analyzed subdivided into three stages: surgical procedure, inpatient care and outpatient clinic. Results the cost of the surgical procedure stage was calculated as 3,798 euros, while that of the inpatient stage was 2,924 euros. The mean hospital costs per procedure amounted to 6,952 euros. Conclusions although the Health Service tariffs fully reimburse the cost of providing a joint replacement, our data contribute to point out the role of hospital staff’s organization to support sustainable improvements on health care for joint replacement surgery. Level of evidence Level VI, single economic evaluation. PMID:26904524

  2. The Cruciate Ligaments in Total Knee Arthroplasty.

    PubMed

    Parcells, Bertrand W; Tria, Alfred J

    2016-01-01

    The early knee replacements were hinge designs that ignored the ligaments of the knee and resurfaced the joint, allowing freedom of motion in a single plane. Advances in implant fixation paved the way for modern designs, including the posterior-stabilized (PS) total knee arthroplasty (TKA) that sacrifices both cruciate ligaments while substituting for the posterior cruciate ligament (PCL), and the cruciate-retaining (CR) TKA designs that sacrifice the anterior cruciate ligament but retain the PCL. The early bicruciate retaining (BCR) TKA designs suffered from loosening and early failures. Townley and Cartier designed BCR knees that had better clinical results but the surgical techniques were challenging.Kinematic studies suggest that normal motion relies on preservation of both cruciate ligaments. Unicompartmental knee arthroplasty retains all knee ligaments and closely matches normal motion, while PS and CR TKA deviate further from normal. The 15% to 20% dissatisfaction rate with current TKA has renewed interest in the BCR design. Replication of normal knee kinematics and proprioception may address some of the dissatisfaction.

  3. Preliminaries toward studying resonant extraction from the Debuncher

    SciTech Connect

    Michelotti, Leo; Johnstone, John; /Fermilab

    2009-06-01

    A recent proposal to detect {mu} {yields} e direct conversion at Fermilab asks for slow extraction of protons from the antiproton source, specifically from the Debuncher. [1] A third-integer resonance originally was considered for this, partly because of the Debuncher's three-fold symmetry and partly because its operational horizontal tune, {nu}{sub x} {approx} 9.765, is already within 0.1 of {nu}{sub x} = 29/3. Using a half integer resonance, {nu}{sub x} = 19/2, though not part of the original proposal, has been suggested more recently because (a) Fermilab has had a good deal of experience with half-integer extraction from the Tevatron, the Main Injector and the erstwhile Main Ring, and (b) for reasons we shall examine later, it depopulates the entire bunch without an abort at the end. This memo presents considerations preliminary to studying both possibilities. It is meant only as a starting point for investigations to be carried out in the future. The working constraints and assumptions have oscillated between two extremes: (1) making minimal changes in the antiproton source to minimize cost and (2) building another machine in the same tunnel. In this memo we adopt an attitude aligned more toward the first. The assumed parameters are listed in Table 1. A few are not (easily) subject to change, such as those related to the beam's momentum and revolution frequency and the acceptance of the debuncher. Two resonance exemplars are presented in the next section, with an explanation of the analytic and semi-analytic calculations that can be done for each. Section 3 contains preliminary numerical work that was done to validate the exemplars within the context of extraction from the Debuncher. A final section contains a summary. Following the bibliography, appendices contain (a) a qualitative, conceptual discussion of extraction for the novice, (b) a telegraphic review of the perturbative incantations used to filter the exemplars as principal resonances of quadrupole

  4. Qualifying CT for wrist arthroplasty: extending techniques for total hip arthroplasty to total wrist arthroplasty

    NASA Astrophysics Data System (ADS)

    Alcala, Yvonne; Olivecrona, Henrik; Olivecrona, Lotta; Noz, Marilyn E.; Maguire, Gerald Q., Jr.; Zeleznik, Michael P.; Sollerman, Christer

    2005-04-01

    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.

  5. Post-traumatic immunosuppression is reversed by anti-coagulated salvaged blood transfusion: deductions from studying immune status after knee arthroplasty

    PubMed Central

    Islam, N; Whitehouse, M; Mehendale, S; Hall, M; Tierney, J; O'Connell, E; Blom, A; Bannister,, G; Hinde, J; Ceredig, R; Bradley, B A

    2014-01-01

    Major trauma increases vulnerability to systemic infections due to poorly defined immunosuppressive mechanisms. It confers no evolutionary advantage. Our objective was to develop better biomarkers of post-traumatic immunosuppression (PTI) and to extend our observation that PTI was reversed by anti-coagulated salvaged blood transfusion, in the knowledge that others have shown that non-anti-coagulated (fibrinolysed) salvaged blood was immunosuppressive. A prospective non-randomized cohort study of patients undergoing primary total knee arthroplasty included 25 who received salvaged blood transfusions collected post-operatively into acid–citrate–dextrose anti-coagulant (ASBT cohort), and 18 non-transfused patients (NSBT cohort). Biomarkers of sterile trauma included haematological values, damage-associated molecular patterns (DAMPs), cytokines and chemokines. Salvaged blood was analysed within 1 and 6 h after commencing collection. Biomarkers were expressed as fold-changes over preoperative values. Certain biomarkers of sterile trauma were common to all 43 patients, including supranormal levels of: interleukin (IL)-6, IL-1-receptor-antagonist, IL-8, heat shock protein-70 and calgranulin-S100-A8/9. Other proinflammatory biomarkers which were subnormal in NSBT became supranormal in ASBT patients, including IL-1β, IL-2, IL-17A, interferon (IFN)-γ, tumour necrosis factor (TNF)-α and annexin-A2. Furthermore, ASBT exhibited subnormal levels of anti-inflammatory biomarkers: IL-4, IL-5, IL-10 and IL-13. Salvaged blood analyses revealed sustained high levels of IL-9, IL-10 and certain DAMPs, including calgranulin-S100-A8/9, alpha-defensin and heat shock proteins 27, 60 and 70. Active synthesis during salvaged blood collection yielded increasingly elevated levels of annexin-A2, IL-1β, Il-1-receptor-antagonist, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-17A, IFN-γ, TNF-α, transforming growth factor (TGF)-β1, monocyte chemotactic protein-1 and macrophage inflammatory

  6. Dose-Associated Changes in Gait Parameters in Response to Exercise Programs after Total Knee Arthroplasty: Secondary Analysis of Two Randomized Studies

    PubMed Central

    Piva, Sara R; Farrokhi, Shawn; Almeida, Gustavo; Fitzgerald G, Kelley; Levison, Timothy J; DiGioia, Anthony M

    2016-01-01

    Background Rehabilitation plays an important role to improve the outcomes of total knee arthroplasty (TKA). Evidence about the appropriate dose of exercise to recover gait dysfunction after TKA is limited. We posed the research question: In patients during the post-acute stage after TKA, is increased dose of exercise associated with larger improvements in gait parameters such as step length and single support time? Methods This was a secondary analysis from two randomized studies on exercise after TKA to investigate dose-dependence of gait parameters in response to exercise. Participants were 50 years or older who underwent unilateral TKA at least two months prior. They participated in 2 months of supervised exercises followed by 4 months of a home exercise program. The primary outcome was change in gait parameters from baseline to 6 months. Participants were divided in three groups according to the dose of exercise: group 1 (light-to-moderate intensity exercise), group 2 (high intensity + functional exercise), and group 3 (high intensity + functional + balance exercise). Jonckheere-Terpstra test was used to test if the magnitude of changes in gait parameters increased from group 1 to group 3 in an ordered fashion. Results Increased dose of exercise was associated with progressive increases in step length in the operated-limb (p=0.008) and decreases in step length in the non-operated limb (p=0.011). Increased dose of exercise was associated with ordinal decreases in loading response time (p=0.049) and increases in single-leg support time (p=0.021) on the operated- limb, but not on the non-operated-limb. Increased dose of exercise was associated with decreases in unloading time on the non-operated-limb (p=0.011) but not on the operated-limb (p=0.400). Conclusions Significant dose-response of exercise on gait parameters support the promotion of more intensive exercise programs that combine functional and balance training programs after TKA. PMID:27019858

  7. Osteonecrosis: avoiding total hip arthroplasty.

    PubMed

    Hungerford, David S

    2002-06-01

    Osteonecrosis of the femoral head afflicts approximately 20,000 new patients per year, at an average age of 38. Of the patients seen in our institution, 25% are <25 years old. Without treatment, most of these patients can be expected to need a total hip arthroplasty. Joint-preserving procedures have a significant failure rate, and some have significant morbidity. It is desirable to avoid or delay total hip arthroplasty because most patients with osteonecrosis outlive the current state-of-the-art prostheses. Four issues need to be weighed to arrive at a reasonable algorithm for the preservative treatment of osteonecrosis: i) patient risk factors, ii) morbidity of the proposed procedure, iii) size of the lesion, and iv) stage of the lesion. All of the issues must be considered to make sense out of a complex clinical situation.

  8. NAVIGATION IN TOTAL KNEE ARTHROPLASTY

    PubMed Central

    da Mota e Albuquerque, Roberto Freire

    2015-01-01

    Navigation was the most significant advance in instrumentation for total knee arthroplasty over the last decade. It provides surgeons with a precision tool for carrying out surgery, with the possibility of intraoperative simulation and objective control over various anatomical and surgical parameters and references. Since the first systems, which were basically used to control the alignment of bone cutting referenced to the mechanical axis of the lower limb, many other surgical steps have been incorporated, such as component rotation, ligament balancing and arranging the symmetry of flexion and extension spaces, among others. Its efficacy as a precision tool with an effective capacity for promoting better alignment of the lower-limb axis has been widely proven in the literature, but the real value of optimized alignment and the impact of navigation on clinical results and the longevity of arthroplasty have yet to be established. PMID:27026979

  9. Humeral windows in revision total elbow arthroplasty

    PubMed Central

    Salama, Amir; Stanley, David

    2016-01-01

    The use of cortical windows for revision elbow arthroplasty has not previously been widely reported. Their use aids safe revision of a well fixed humeral prosthesis and can be used in the setting of dislocation, periprosthetic fracture or aseptic loosening of the ulnar component. We describe our technique and results of cortical windows in the distal humerus for revision elbow arthroplasty surgery. PMID:27583011

  10. Humeral windows in revision total elbow arthroplasty.

    PubMed

    Peach, Chris A; Salama, Amir; Stanley, David

    2016-04-01

    The use of cortical windows for revision elbow arthroplasty has not previously been widely reported. Their use aids safe revision of a well fixed humeral prosthesis and can be used in the setting of dislocation, periprosthetic fracture or aseptic loosening of the ulnar component. We describe our technique and results of cortical windows in the distal humerus for revision elbow arthroplasty surgery. PMID:27583011

  11. Reducing arthroplasty costs via vendor contracts

    PubMed Central

    Johnston, D. William C.; Beaupré, Lauren A.; Davies, Donna M.; Hessels, Rick

    1999-01-01

    Objective To describe a method of reducing the costs of implants in hip and knee arthroplasty. Design Implant costs were compared before and after the implementation of a 2-year contract with implant vendors, providing increased volume for decreased implant cost. An additional 20% of arthroplasties could be done outside the contract for research or special purposes. Setting A regional health authority involving 2 acute care hospitals. Method Costs were obtained for 942 hip and knee arthroplasties performed in 1993/94 and compared with costs of 1656 hip and knee arthroplasties performed in 1996/97. Outcome Measures Implant cost and number of joint arthroplasty procedures performed. Results A 40% decrease in the cost per implant for primary knee arthroplasty and an 18% decrease in the cost per implant for primary hip arthroplasty were achieved. A rebate, calculated as a percentage of volume used, was received from the vendor to support general orthopedic research and education. A new contract for 3 years has recently been signed with 3 vendors designated as primary vendors for 80% of the volume. Conclusion The vendor-contract economic strategy effectively reduced the cost of hip and knee arthroplasty and may be useful at other centres looking for cost reduction methods that maintain adequate patient care and support clinical research and education. PMID:10593246

  12. Characterization of hip and knee arthroplasties and factors associated with infection☆

    PubMed Central

    da Silva Pinto, Cibele Zdebsky; Alpendre, Francine Taporosky; Stier, Christiane Johnscher Niebel; Maziero, Eliane Cristina Sanches; de Alencar, Paulo Gilberto Cimbalista; de Almeida Cruz, Elaine Drehmer

    2015-01-01

    Objective To characterize arthroplasty procedures, calculate the surgical infection rate and identify related risk factors. Methods This was a retrospective cohort study. Data on operations performed between 2010 and 2012 were gathered from documental sources and were analyzed with the aid of statistical software, using Fisher's exact test, Student's t test and the nonparametric Mann–Whitney and Wilcoxon tests. Results 421 total arthroplasty procedures performed on 346 patients were analyzed, of which 208 were on the knee and 213 on the hip. It was found that 18 patients (4.3%) were infected. Among these, 15 (83.33%) were reoperated and 2 (15.74%) died. The prevalence of infection in primary total hip arthroplasty procedures was 3%; in primary total knee arthroplasty, 6.14%; and in revision of total knee arthroplasty, 3.45%. Staphylococcus aureus was prevalent. The length of the surgical procedure showed a tendency toward being a risk factor (p = 0.067). Conclusion The prevalence of infection in cases of primary total knee arthroplasty was greater than in other cases. No statistically significant risk factors for infection were identified. PMID:27218082

  13. Preliminary Trade Study of Phase Change Heat Sinks

    NASA Technical Reports Server (NTRS)

    Anderson, Molly; Leimkeuhler, Thomas; Quinn, Gregory; Golliher, Eric

    2006-01-01

    For short durations, phase change based heat rejection systems are a very effective way of removing heat from spacecraft. Future NASA vehicles, such as the Crew Exploration Vehicle (CEV), will require non-radiative heat rejection systems during at least a portion of the planned mission, just as their predecessors have. While existing technologies are available to modify, such as Apollo era sublimators, or the Space Shuttle Flash Evaporator System (FES), several new technologies are under development or investigation to progress beyond these existing heat rejection systems. Examples include the Multi-Fluid Evaporator developed by Hamilton Sundstrand, improvements upon the Contaminant Insensitive Sublimator originally developed for the X-38 program, and a Compact Flash Evaporator System (CFES). Other possibilities evaluate new ways of operating existing designs. The new developments are targeted at increasing operating life, expanding the environments in which the system can operate, improving the mass and volume characteristics, or some combination of these or other improvements. This paper captures the process and results of a preliminary trade study performed at Johnson Space Center to compare the various existing and proposed phase change based heat rejection systems for the CEV. Because the new systems are still in development, and the information on existing systems is extrapolation, this trade study is not meant to suggest a final decision for future vehicles. The results of this early trade study are targeted to aid the development efforts for the new technologies by identifying issues that could reduce the chances of selection for the CEV.

  14. Preliminary Study of a Model Rotor in Descent

    NASA Technical Reports Server (NTRS)

    McAlister, K. W.; Tung, C.; Sharpe, D. L.; Huang, S.; Hendley, E. M.

    2000-01-01

    Within a program designed to develop experimental techniques for measuring the trajectory and structure of vortices trailing from the tips of rotor blades, the present preliminary study focuses on a method for quantifying the trajectory of the trailing vortex during descent flight conditions. This study also presents rotor loads and blade surface pressures for a range of tip-path plane angles and Mach numbers. Blade pressures near the leading edge and along the outer radius are compared with data obtained on the same model rotor, but in open jet facilities. A triangulation procedure based on two directable laser-light sheets, each containing an embedded reference, proved effective in defining the spatial coordinates of the trailing vortex. When interrogating a cross section of the flow that contains several trailing vortices, the greatest clarity was found to result when the flow is uniformly seeded. Surface pressure responses during blade-vortex interactions appeared equally sensitive near the leading edge and along the outer portion of the blade, but diminished rapidly as the distance along the blade chord increased. The pressure response was virtually independent of whether the tip-path plane angle was obtained through shaft tilt or cyclic pitch. Although the shape and frequency of the pressure perturbations on the advancing blade during blade-vortex interaction are similar to those obtained in open-jet facilities, the angle of the tip-path plane may need to be lower than the range covered in this study.

  15. Preliminary studies to determine the shelf life of HEPA filters

    SciTech Connect

    Gilbert, H.; Fretthold, J.K.; Rainer, F.; Bergman, W.; Beason, D.

    1994-07-18

    We have completed a preliminary study using filter media tests and filter qualification tests to investigate the effect of shelf-life on HEPA filter performance. Our media studies showed that the tensile strength decreased with age, but the data were not sufficient to establish a shelf-life. Thermogravimetric analyses demonstrated that one manufacturer had media with low tensile strength due to insufficient binder. The filter qualification tests (heated air and overpressure) conducted on different aged filters showed that filter age is not the primary factor affecting filter performance; materials and the construction design have a greater effect. An unexpected finding of our study was that sub-standard HEPA filters have been installed in DOE facilities despite existing regulations and filter qualification tests. We found that the filter with low tensile strength failed the overpressure test. The same filter had passed the heated air test, but left the filter so structurally weak, it was prone to blowout. We recommend that DOE initiate a filter qualification program to prevent this occurrence.

  16. Preliminary studies to determine the shelf life of HEPA filters

    SciTech Connect

    Gilbert, H.; Fretthold, J.K.; Rainer, F.

    1995-02-01

    We have completed a preliminary study using filter media tests and filter qualification tests to investigate the effect of shelf-life on HEPA filter performance. Our media studies showed that the tensile strength decreased with age, but the data were not sufficient to establish a shelf-life. Thermogravimetric analyses demonstrated that one manufacturer had media with low tensile strength due to insufficient binder. The filter qualification tests (heated air and overpressure) conducted on different aged filters showed that filter age is not the primary factor affecting filter performance; materials and the construction design have a greater effect. An unexpected finding of our study was that sub-standard HEPA filters have been installed in DOE facilities despite existing regulations and filter qualification tests. We found that the filter with low tensile strength failed the overpressure test. The same filter had passed the heated air test, but left the filter so structurally weak, it was prone to blow-out. We recommend that DOE initiate a filter qualification program to prevent this occurrence.

  17. Archaeoastronomical Information in the Study of Cremation Necropolis: Preliminary Study

    NASA Astrophysics Data System (ADS)

    Mejuto, J.; Cerde, M. L.; Rodríguez, C.

    2009-08-01

    This work remarks the significance that archaeoastronomical studies have for archaeological research. These studies provide us data about the perception that ancient societies had about astronomical events and how these facts were added to their religious and ideological world. Thus, archaeoastronomy become a valuable source of information when aimed to solve any question involving the ancient societies. We take as reference in this work some of the Late Bronze Age{'}s cremation necropolis, representatives of usually called Urnfields, to check if their design can be related to some celestial phenomena: Can Bech de Baix (Gerona), Can Pitieu-Can Roqueta(Barcelona), Molá (Tarragona), Can Missert (Tarragona), Les Obagues (Tarragona), La Colomina (Lleida) and La Torraza (Navarra). Likewise a new standard in archaeological excavations maps is proposed. This will allow getting the information more available and improving further studies.

  18. Preliminary design studies on the Broad Application Test Reactor

    SciTech Connect

    Terry, W.J.; Terry, W.K.; Ryskamp, J.M.; Jahshan, S.N.; Fletcher, C.D.; Moore, R.L.; Leyse, C.F.; Ottewitte, E.H.; Motloch, C.G.; Lacy, J.M.

    1992-08-01

    This report describes progress made at the Idaho National Engineering Laboratory during the first three quarters of Fiscal Year (FY) 1992 on the Laboratory-Directed Research and Development (LDRD) project to perform preliminary design studies on the Broad Application Test Reactor (BATR). This work builds on the FY-92 BATR studies, which identified anticipated mission and safety requirements for BATR and assessed a variety of reactor concepts for their potential capability to meet those requirements. The main accomplishment of the FY-92 BATR program is the development of baseline reactor configurations for the two conventional conceptual test reactors recommended in the FY-91 report. Much of the present report consists of descriptions and neutronics and thermohydraulics analyses of these baseline configurations. In addition, we considered reactor safety issues, compared the consequences of steam explosions for alternative conventional fuel types, explored a Molten Chloride Fast Reactor concept as an alternate BATR design, and examined strategies for the reduction of operating costs. Work planned for the last quarter of FY-92 is discussed, and recommendations for future work are also presented.

  19. Intraarterial Ultrasound in Pancreatic Cancer: Feasibility Study and Preliminary Results

    SciTech Connect

    Larena-Avellaneda, Axel; Timm, Stephan; Kickuth, Ralph; Kenn, Werner; Steger, Ulrich; Jurowich, Christian; Germer, Christoph-Thomas

    2010-08-15

    Despite technological advances in computed tomography (CT) and magnetic resonance imaging, the involvement of the celiac or mesenteric artery in pancreatic cancer remains uncertain in many cases. Infiltration of these vessels is important in making decisions about therapy choices but often can only be definitively determined through laparotomy. Local (intraarterial) ultrasound may increase diagnostic accuracy. Using the Volcano intravascular ultrasound (IVUS) system, we applied a transfemoral method to scan the celiac and mesenteric arteries directly intraarterial. This technique was used in five patients with suspected pancreatic cancer. Technical success was achieved in all cases. In one case, a short dissection of the mesenteric artery occurred but could be managed interventionally. In tumors that did not contact with the vessels, IVUS was unable to display the tissue pathology. Our main interest was the infiltration of the arteries. In one case, infiltration was certain in the CT scan but uncertain in two patients. In the latter two cases, IVUS correctly predicted infiltration in one and freedom from tumor in the other case. In our preliminary study, IVUS correctly predicted arterial infiltration in all cases. IVUS did not provide new information when the tumor was far away from the vessel. Compared with IVUS in the portal vein, the information about the artery is more detailed, and the vessel approach is easier. These results encouraged us to design a prospective study to evaluate the sensitivity and specificity of this method.

  20. Energy efficient engine preliminary design and integration study

    NASA Technical Reports Server (NTRS)

    Gray, D. E.

    1978-01-01

    The technology and configurational requirements of an all new 1990's energy efficient turbofan engine having a twin spool arrangement with a directly coupled fan and low-pressure turbine, a mixed exhaust nacelle, and a high 38.6:1 overall pressure ratio were studied. Major advanced technology design features required to provide the overall benefits were a high pressure ratio compression system, a thermally actuated advanced clearance control system, lightweight shroudless fan blades, a low maintenance cost one-stage high pressure turbine, a short efficient mixer and structurally integrated engine and nacelle. A conceptual design analysis was followed by integration and performance analyses of geared and direct-drive fan engines with separate or mixed exhaust nacelles to refine previously designed engine cycles. Preliminary design and more detailed engine-aircraft integration analysis were then conducted on the more promising configurations. Engine and aircraft sizing, fuel burned, and airframe noise studies on projected 1990's domestic and international aircraft produced sufficient definition of configurational and advanced technology requirements to allow immediate initiation of component technology development.

  1. Thulium-170-labeled microparticles for local radiotherapy: preliminary studies.

    PubMed

    Polyak, Andras; Das, Tapas; Chakraborty, Sudipta; Kiraly, Reka; Dabasi, Gabriella; Joba, Robert Peter; Jakab, Csaba; Thuroczy, Julianna; Postenyi, Zita; Haasz, Veronika; Janoki, Gergely; Janoki, Gyozo A; Pillai, Maroor R A; Balogh, Lajos

    2014-10-01

    The present article describes the preparation, characterization, and biological evaluation of Thulium-170 ((170)Tm) [T1/2 = 128.4 days; Eβmax = 968 keV; Eγ = 84 keV (3.26%)] labeled tin oxide microparticles for its possible use in radiation synovectomy (RSV) of medium-sized joints. (170)Tm was produced by irradiation of natural thulium oxide target. 170Tm-labeled microparticles were synthesized with high yield and radionuclidic purity (> 99%) along with excellent in vitro stability by following a simple process. Particle sizes and morphology of the radiolabeled particles were examined by light microscope, dynamic light scattering, and transmission electron microscope and found to be of stable spherical morphology within the range of 1.4-3.2 μm. The preparation was injected into the knee joints of healthy Beagle dogs intraarticularly for biological studies. Serial whole-body and regional images were taken by single-photon-emission computed tomography (SPECT) and SPECT-CT cameras up to 9 months postadministration, which showed very low leakage (< 8% of I.D.) of the instilled particles. The majority of leaked radiocolloid particles were found in inguinal lymph nodes during the 9 months of follow-up. All the animals tolerated the treatment well; the compound did not show any possible radiotoxicological effect. These preliminary studies showed that 170Tm-labeled microparticles could be a promising nontoxic and effective radiopharmaceutical for RSV applications or later local antitumor therapy.

  2. A preliminary study of Mars rover/sample return missions

    NASA Technical Reports Server (NTRS)

    1987-01-01

    The Solar System Exploration Committee (SSEC) of the NASA Advisory Council recommends that a Mars Sample Return mission be undertaken before the year 2000. Comprehensive studies of a Mars Sample Return mission have been ongoing since 1984. The initial focus of these studies was an integrated mission concept with the surface rover and sample return vehicle elements delivered to Mars on a single launch and landed together. This approach, to be carried out as a unilateral U.S. initiative, is still a high priority goal in an Augmented Program of exploration, as the SSEC recommendation clearly states. With this background of a well-understood mission concept, NASA decided to focus its 1986 study effort on a potential opportunity not previously examined; namely, a Mars Rover/Sample Return (MRSR) mission which would involve a significant aspect of international cooperation. As envisioned, responsibility for the various mission operations and hardware elements would be divided in a logical manner with clearly defined and acceptable interfaces. The U.S. and its international partner would carry out separately launched but coordinated missions with the overall goal of accomplishing in situ science and returning several kilograms of surface samples from Mars. Important considerations for implementation of such a plan are minimum technology transfer, maximum sharing of scientific results, and independent credibility of each mission role. Under the guidance and oversight of a Mars Exploration Strategy Advisory Group organized by NASA, a study team was formed in the fall of 1986 to develop a preliminary definition of a flight-separable, cooperative mission. The selected concept assumes that the U.S. would undertake the rover mission with its sample collection operations and our international partner would return the samples to Earth. Although the inverse of these roles is also possible, this study report focuses on the rover functions of MRSR because rover operations have not

  3. Predictors of Satisfaction Following Total Knee Arthroplasty.

    PubMed

    Maratt, Joseph D; Lee, Yuo-yu; Lyman, Stephen; Westrich, Geoffrey H

    2015-07-01

    Despite the success of total knee arthroplasty (TKA), numerous studies report that nearly one in five patients who underwent TKA was unsatisfied with their outcome. The purpose of our study was to identify the preoperative factors predictive of satisfaction following well-performed TKA. Using improvement in patient-reported outcomes less than the minimally clinically important change as an indicator of dissatisfaction in a cohort of primary TKA patients, we found that patients with greater preoperative pain and disability with less severe degradation in health-related quality of life were more likely to be satisfied with the result of TKA. Balancing severity of symptoms and impact to quality of life is important when counseling patients considering TKA.

  4. ECG response of koalas to tourists proximity: a preliminary study.

    PubMed

    Ropert-Coudert, Yan; Brooks, Lisa; Yamamoto, Maki; Kato, Akiko

    2009-01-01

    Koalas operate on a tight energy budget and, thus, may not always display behavioral avoidance reaction when placed in a stressful condition. We investigated the physiological response of captive koalas Phascolarctos cinereus in a conservation centre to the presence of tourists walking through their habitat. We compared, using animal-attached data-recorders, the electrocardiogram activity of female koalas in contact with tourists and in a human-free area. One of the koalas in the tourist zone presented elevated heart rate values and variability throughout the recording period. The remaining female in the exhibit area showed a higher field resting heart rates during the daytime than that in the isolated area. In the evening, heart rate profiles changed drastically and both the koalas in the exhibit and in the tourist-free zones displayed similar field resting heart rates, which were lower than those during the day. In parallel, the autonomic nervous systems of these two individuals evolved from sympathetic-dominant during the day to parasympathetic-dominant in the evening. Our results report ECG of free-living koalas for the first time. Although they are preliminary due to the difficulty of having sufficient samples of animals of the same sex and age, our results stress out the importance of studies investigating the physiological reaction of animals to tourists. PMID:19823679

  5. Hypoallergenic properties of donkey's milk: a preliminary study.

    PubMed

    Vincenzetti, Silvia; Foghini, Laura; Pucciarelli, Stefania; Polzonetti, Valeria; Cammertoni, Natalina; Beghelli, Daniela; Polidori, Paolo

    2014-01-01

    Cow's milk protein allergy (CMPA) is an abnormal immunological response to cow milk proteins, which results in IgE-mediated reactions. The therapeutic strategy to respond to CMPA envisages the total elimination of milk or the administration of cow's milk substitutes. For this reason the use of milk from other mammalian species was tested. Among them, donkey's milk proved to be the best alternative in feeding infants affected by CMPA, since its chemical composition is comparable to human milk. In this work an in vitrostudy was performed in order to analyze the IgE reactivity to milk protein allergens from cow, donkey and goat. In particular, immunoblotting experiments using sera from milk-allergic and non-allergic adult volunteers were conducted with the aim of verifying the hypoallergenic property of donkey's milk. This study provided a preliminary evidence of the hypoallergenicity of donkey's milk when compared to bovine and goat milk. Considering the obtained results, it would be possible to develop a sensitive diagnostic method for CMPA detection, based on chromatographic and immunoblotting analysis.

  6. Textual appropriation in engineering master's theses: a preliminary study.

    PubMed

    Eckel, Edward J

    2011-09-01

    In the thesis literature review, an engineering graduate student is expected to place original research in the context of previous work by other researchers. However, for some students, particularly those for whom English is a second language, the literature review may be a mixture of original writing and verbatim source text appropriated without quotations. Such problematic use of source material leaves students vulnerable to an accusation of plagiarism, which carries severe consequences. Is such textual appropriation common in engineering master's writing? Furthermore, what, if anything, can be concluded when two texts have been found to have textual material in common? Do existing definitions of plagiarism provide a sufficient framework for determining if an instance of copying is transgressive or not? In a preliminary attempt to answer these questions, text strings from a random sample of 100 engineering master's theses from the ProQuest Dissertations and Theses database were searched for appropriated verbatim source text using the Google search engine. The results suggest that textual borrowing may indeed be a common feature of the master's engineering literature review, raising questions about the ability of graduate students to synthesize the literature. The study also illustrates the difficulties of making a determination of plagiarism based on simple textual similarity. A context-specific approach is recommended when dealing with any instance of apparent copying.

  7. Normal use levels of respirable cosmetic talc: preliminary study.

    PubMed

    Aylott, R I; Byrne, G A; Middleton, J D; Roberts, M E

    1979-06-01

    Synopsis This preliminary study was undertaken to provide data from which a more comprehensive investigation to establish the safety in-use of cosmetic talcs could be designed. Methods for collecting and analysing respirable talc generated during the use of loose face powder and adult and baby dusting powders were established. Respirable particles in the air were separated from larger size particles by means of a cyclone and were collected on membrane filters. The collected dust was dissolved in acid and the solution was analysed for magnesium by atomic absorption spectroscopy. From the results the concentrations of talc in the air samples were calculated. The method was used to monitor the in-use levels of a range of cosmetic talcs. Mean concentrations in air sampled for 5 min from the start of use of Chinese grades and Italian 00000 grades of talc formulated for use as loose face powder, adult dusting powder and baby dusting powder were 0.48, 1.13 and 0.21 mg m(-3), respectively. Higher levels were found with micronised adult dusting powder (mean concentration 1.9 mg m(-3)). There was no evidence that the presence of perfume in the talc or the ambient relative humidity in the range 54-74% during use affected the levels of respirable talc, but high relative humidity <90% reduced the amount of respirable talc.

  8. Chemical components of shredded paper insulation: A preliminary study

    SciTech Connect

    Kelman, B.J.; Swenson, L.J.; Uppala, L.V.; Cohen, J.M.; Millette, J.R.; Mueller, W.F.

    1999-03-01

    The authors conducted an evaluation of shredded paper insulation to identify potentially toxic components. The study was to provide a preliminary characterization of a few samples of insulation currently in use. The following samples were analyzed: previously produced insulation (PPI) containing fire retardants, shredded recycled paper (PPI feedstock), freshly produced insulation (FPI), and insulation which had been installed in a residence (II). Volatile constituents were analyzed by GC-MS from headspace air of samples held at room temperature or heated to 90 C. Extractable constituents were sampled by extracting with methylene chloride, and analyzing by GC-MS. Formaldehyde analysis was done according to EPA Method TO11. Headspace air at room temperature contained no detectable quantities of volatile constituents for any sample measured. In headspace air at 90 C, only PPI contained traces of aliphatic and aromatic hydrocarbons and higher aldehydes, and FPI traces of toluene. Extracts of PPI contained traces of octadecadienoic acid methyl ester and aliphatic and aromatic hydrocarbons and higher aldehydes. Extracts of PPI feedstock contained traces of a substituted cyclohexenecarboxylic acid. FPI contained extractable diethyl phthalate. Extracts of (II) contained traces of methyl palmitate, an octadecenoic acid methyl ester, and a phthalate plasticizer. Boron and sodium were expected and confirmed because they were added to PPI and FPI as fire retardants. Chromium, copper, iron, potassium, magnesium, manganese, phosphorus, and silicon were present at detectable concentrations.

  9. Preliminary design studies on a nuclear seawater desalination system

    SciTech Connect

    Wibisono, A. F.; Jung, Y. H.; Choi, J.; Kim, H. S.; Lee, J. I.; Jeong, Y. H.; No, H. C.

    2012-07-01

    Seawater desalination is one of the most promising technologies to provide fresh water especially in the arid region. The most used technology in seawater desalination are thermal desalination (MSF and MED) and membrane desalination (RO). Some developments have been done in the area of coupling the desalination plant with a nuclear reactor to reduce the cost of energy required in thermal desalination. The coupling a nuclear reactor to a desalination plant can be done either by using the co-generation or by using dedicated heat from a nuclear system. The comparison of the co-generation nuclear reactor with desalination plant, dedicated nuclear heat system, and fossil fueled system will be discussed in this paper using economical assessment with IAEA DEEP software. A newly designed nuclear system dedicated for the seawater desalination will also be suggested by KAIST (Korea Advanced Inst. of Science and Technology) research team and described in detail within this paper. The suggested reactor system is using gas cooled type reactor and in this preliminary study the scope of design will be limited to comparison of two cases in different operating temperature ranges. (authors)

  10. Bio-Contamination Control for Spacesuit Garments - A Preliminary Study

    NASA Technical Reports Server (NTRS)

    Rhodes, Richard; Korona, Adam; Orndoff, Evelyn; Ott, Mark; Poritz, Darwin

    2010-01-01

    This paper outlines a preliminary study to review, test, and improve upon the current state of spacesuit bio-contamination control. The study includes an evaluation of current and advanced suit materials, ground and on-orbit cleaning methods, and microbial test and analysis methods. The first aspect of this study was to identify potential anti-microbial textiles and cleaning agents, and to review current microbial test methods. The anti-microbial cleaning agent and textile market survey included a review of current commercial-off-the-shelf (COTS) products that could potentially be used as future space flight hardware. This review included replacements for any of the softgood layers that may become contaminated during an extravehicular activity (EVA), including the pressure bladder, liquid cooling garment, and ancillary comfort undergarment. After a series of COTS anti-microbial textiles and clean ing agents were identified, a series of four tests were conducted: (1) a stacked configuration test that was conducted in order to review how bio-contamination would propagate through the various suit layers, (2) a individual materials test that evaluated how well each softgood layer either promoted or repressed growth, (3) a cleaning agent test that evaluated the efficacy on each of the baseline bladders, and (4) an evaluation of various COTS anti-microbial textiles. All antimicrobial COTS materials tested appeared to control bacteria colony forming unit (CFU) growth better than the Thermal Comfort Undergarment (TCU) and ACES Liquid Cooling Garment (LCG)/EMU Liquid Cooling Ventilation Garment (LCVG) materials currently in use. However, a comparison of fungi CFU growth in COTS to current suit materials appeared to vary per material. All cleaning agents tested in this study appeared to inhibit the level of bacteria and fungi growth to acceptable levels for short duration tests. While several trends can be obtained from the current analysis, a series of test improvements are

  11. In vivo determination of total knee arthroplasty kinematics

    SciTech Connect

    Komistek, Richard D; Mahfouz, Mohamed R; Bertin, Kim; Rosenberg, Aaron; Kennedy, William

    2008-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  13. A preliminary magnetic study of Sawa lake sediments, Southern Iraq

    NASA Astrophysics Data System (ADS)

    Ameen, Nawrass

    2016-04-01

    A preliminary magnetic study combined with chemical analyses was carried out in Sawa Lake in Al-Muthanna province, southern Iraq, about 22 km south west of Samawa city (31°18'48.80"N, 45°0'25.25"E). The lake is about 4.74 km length, 1.75 km width and 5.5 m height, it is surrounded by a salt rim which is higher than the lake water by about 2.8 m and sea water by about 18.5 m (Naqash et al., 1977 in Hassan, 2007). The lake is an elongated closed basin with no surface water available to it, it may be fed by groundwater of the Euphrates and Dammam aquifers through system of joints and cracks. This study aims to investigate the concentrations of selected heavy metals as pollutants and magnetic susceptibility (MS) and other magnetic properties of sediment samples from fifty sites collected from the bottom of the lake, the study area lies in an industrial area. The results show spatial variations of MS with mean value of about 4.58 x 10-8 m3 kg-1. Scanning electron microscopy and magnetic mineralogy parameters indicate the dominance of soft magnetic phase like magnetite and presence of hard magnetic phase like hematite. Spatial variations of MS combined with the concentrations of heavy metals suggests the efficiency of magnetic methods as effective, inexpensive and non-time consuming method to outlining the heavy metal pollution. References: Hassan W.F., 2007. The Physio-chemical characteristic of Sawa lake water in Samawa city-Iraq. Marine Mesopotamica, 22(2), 167-179.

  14. Progress in preliminary studies at Ottana Solar Facility

    NASA Astrophysics Data System (ADS)

    Demontis, V.; Camerada, M.; Cau, G.; Cocco, D.; Damiano, A.; Melis, T.; Musio, M.

    2016-05-01

    The fast increasing share of distributed generation from non-programmable renewable energy sources, such as the strong penetration of photovoltaic technology in the distribution networks, has generated several problems for the management and security of the whole power grid. In order to meet the challenge of a significant share of solar energy in the electricity mix, several actions aimed at increasing the grid flexibility and its hosting capacity, as well as at improving the generation programmability, need to be investigated. This paper focuses on the ongoing preliminary studies at the Ottana Solar Facility, a new experimental power plant located in Sardinia (Italy) currently under construction, which will offer the possibility to progress in the study of solar plants integration in the power grid. The facility integrates a concentrating solar power (CSP) plant, including a thermal energy storage system and an organic Rankine cycle (ORC) unit, with a concentrating photovoltaic (CPV) plant and an electrical energy storage system. The facility has the main goal to assess in real operating conditions the small scale concentrating solar power technology and to study the integration of the two technologies and the storage systems to produce programmable and controllable power profiles. A model for the CSP plant yield was developed to assess different operational strategies that significantly influence the plant yearly yield and its global economic effectiveness. In particular, precise assumptions for the ORC module start-up operation behavior, based on discussions with the manufacturers and technical datasheets, will be described. Finally, the results of the analysis of the: "solar driven", "weather forecasts" and "combined storage state of charge (SOC)/ weather forecasts" operational strategies will be presented.

  15. A preliminary magnetic study of Sawa lake sediments, Southern Iraq

    NASA Astrophysics Data System (ADS)

    Ameen, Nawrass

    2016-04-01

    A preliminary magnetic study combined with chemical analyses was carried out in Sawa Lake in Al-Muthanna province, southern Iraq, about 22 km south west of Samawa city (31°18'48.80"N, 45°0'25.25"E). The lake is about 4.74 km length, 1.75 km width and 5.5 m height, it is surrounded by a salt rim which is higher than the lake water by about 2.8 m and sea water by about 18.5 m (Naqash et al., 1977 in Hassan, 2007). The lake is an elongated closed basin with no surface water available to it, it may be fed by groundwater of the Euphrates and Dammam aquifers through system of joints and cracks. This study aims to investigate the concentrations of selected heavy metals as pollutants and magnetic susceptibility (MS) and other magnetic properties of sediment samples from fifty sites collected from the bottom of the lake, the study area lies in an industrial area. The results show spatial variations of MS with mean value of about 4.58 x 10‑8 m3 kg‑1. Scanning electron microscopy and magnetic mineralogy parameters indicate the dominance of soft magnetic phase like magnetite and presence of hard magnetic phase like hematite. Spatial variations of MS combined with the concentrations of heavy metals suggests the efficiency of magnetic methods as effective, inexpensive and non-time consuming method to outlining the heavy metal pollution. References: Hassan W.F., 2007. The Physio-chemical characteristic of Sawa lake water in Samawa city-Iraq. Marine Mesopotamica, 22(2), 167-179.

  16. Safety and efficacy of multimodal thromboprophylaxis following total knee arthroplasty: a comparative study of preferential aspirin vs. routine coumadin chemoprophylaxis.

    PubMed

    Gesell, Mark W; González Della Valle, Alejandro; Bartolomé García, Sergio; Memtsoudis, Stavros G; Ma, Yan; Haas, Steven B; Salvati, Eduardo A

    2013-04-01

    Multimodal thromboprophylaxis encompasses preoperative VTE risk stratification, regional anesthesia, mechanical prophylaxis, and early mobilization. We determined if aspirin can be safely used for adjuvant chemoprophylaxis in patients who have a low thromboembolic risk. 1016 consecutive patients undergoing TKA received multimodal thromboprophylaxis. Aspirin was used in 67% of patients and Coumadin 33% (high risk patients, or who were on Coumadin before surgery). This study group was compared to 1001 consecutive patients who received multimodal thromboprophylaxis and routine Coumadin chemoprophylaxis. There was no significant difference in rates of VTE, PE, bleeding, complications, readmission and 90-day mortality between the two groups. There was a significantly higher rate of wound related complications in the control group (p=0.03). Multimodal thromboprophylaxis with aspirin given to the majority of patients at a low VTE risk is safe and effective in patients undergoing primary TKA.

  17. Impact of Preemptive Analgesia on inflammatory responses and Rehabilitation after Primary Total Knee Arthroplasty: A Controlled Clinical Study.

    PubMed

    Jianda, Xu; Yuxing, Qu; Yi, Gao; Hong, Zhao; Libo, Peng; Jianning, Zhao

    2016-01-01

    The aim of this study was to investigate the effects of preemptive analgesia on the inflammatory response and rehabilitation in TKA. 75 patients with unilateral primary knee osteoarthritis were conducted in this prospective study. All patients were randomly divided into two groups (MMA with/without preemptive analgesia group). The following parameters were used to evaluate analgesic efficacy: knee flexion, pain at rest and walking, functional walking capacity (2 MWT and 6 MWT), WOMAC score, and hs-CRP level. Patients in MMA with preemptive analgesia group had lower hs-CRP level and less pain at rest and walking during the first week postoperatively (P < 0.05). The 2 MWT was significantly better in MMA with preemptive analgesia group (17.13 ± 3.82 VS 14.19 ± 3.56, P = 0.001). The 6 MWT scores and WOMAC scores increased significantly within Groups (P = 0.020, 0.000), but no difference between groups postoperatively (P > 0.05). Less cumulative consumption of morphine was found in MMA with preemptive analgesia group at 48 h (P = 0.017, 0.023), but no difference at total requirement (P = 0.113). Preemptive analgesia added to a multimodal analgesic regime improved analgesia, reduced inflammatory reaction and accelerated functional recovery at the first week postoperatively, but not improved long-term function. PMID:27578313

  18. Impact of Preemptive Analgesia on inflammatory responses and Rehabilitation after Primary Total Knee Arthroplasty: A Controlled Clinical Study

    PubMed Central

    Jianda, Xu; Yuxing, Qu; Yi, Gao; Hong, Zhao; Libo, Peng; Jianning, Zhao

    2016-01-01

    The aim of this study was to investigate the effects of preemptive analgesia on the inflammatory response and rehabilitation in TKA. 75 patients with unilateral primary knee osteoarthritis were conducted in this prospective study. All patients were randomly divided into two groups (MMA with/without preemptive analgesia group). The following parameters were used to evaluate analgesic efficacy: knee flexion, pain at rest and walking, functional walking capacity (2 MWT and 6 MWT), WOMAC score, and hs-CRP level. Patients in MMA with preemptive analgesia group had lower hs-CRP level and less pain at rest and walking during the first week postoperatively (P < 0.05). The 2 MWT was significantly better in MMA with preemptive analgesia group (17.13 ± 3.82 VS 14.19 ± 3.56, P = 0.001). The 6 MWT scores and WOMAC scores increased significantly within Groups (P = 0.020, 0.000), but no difference between groups postoperatively (P > 0.05). Less cumulative consumption of morphine was found in MMA with preemptive analgesia group at 48 h (P = 0.017, 0.023), but no difference at total requirement (P = 0.113). Preemptive analgesia added to a multimodal analgesic regime improved analgesia, reduced inflammatory reaction and accelerated functional recovery at the first week postoperatively, but not improved long-term function. PMID:27578313

  19. Rotating platform knees did not improve patellar tracking: a prospective, randomized study of 240 primary total knee arthroplasties.

    PubMed

    Pagnano, Mark W; Trousdale, Robert T; Stuart, Michael J; Hanssen, Arlen D; Jacofsky, David J

    2004-11-01

    Renewed interest in mobile-bearing total knee replacement designs has been generated by the concept of self alignment and the suggestion that those designs can accommodate small mismatches in the rotational position of the tibial and femoral components. Self alignment might improve patellar tracking, decrease the prevalence of lateral retinacular release and postoperative patellar tilt or subluxation, improve knee flexion, and improve patellofemoral function during daily activities such as stair climbing. This prospective randomized study of 240 patients used a single posterior-stabilized femoral component and included three groups of 80 patients: an all-polyethylene group, a modular metal-backed group, and a rotating platform tibia group. The prevalence of lateral retinacular release was 3.8% in each group. The prevalence of patellar tilt was 5% (all-polyethylene group), 7% (modular metal-backed group), and 11% (rotating platform group). Preoperative motion was not significantly different and both the 3-month flexion (112 degrees , 110 degrees , and 108 degrees ) and 1-year flexion (116 degrees , 117 degrees , and 115 degrees ) were not significantly different among the all-polyethylene, modular metal-backed, and rotating platform groups, respectively. Preoperative stair climbing scores were not significantly different and both the 3-month (38, 41, and 35 points) and 1-year (44, 46, and 42 points) scores were not significantly different. In this prospective randomized study, the rotating platform knee design did not decrease the prevalence of lateral retinacular release or patellar tilt or subluxation and did not increase knee flexion or improve stair climbing ability at 3 months or at 1 year postoperatively when compared with a posterior-stabilized, fixed-bearing knee.

  20. Anatomic Versus Mechanically Aligned Total Knee Arthroplasty for Unicompartmental Knee Arthroplasty Revision

    PubMed Central

    Toliopoulos, Panagiota; LeBlanc, Marc-Andre; Hutt, Jonathan; Lavigne, Martin; Desmeules, Francois; Vendittoli, Pascal-Andre

    2016-01-01

    Objectives: The purpose of this study was to compare the intra-operative benefits and the clinical outcomes from kinematic or mechanical alignment for total knee arthroplasty (TKA) in patients undergoing revision of failed unicompartmental kneel arthroplasty (UKA) to TKA. Methods: Ten revisions were performed with a kinematic alignment technique and 11 with a mechanical alignment. Measurements of the hip-knee-ankle angle (HKA), the lateral distal femoral angle (LDFA), and the medial proximal tibial angle (MPTA) were performed using long-leg radiographs. The need for augments, stems, and constrained inserts was compared between groups. Clinical outcomes were compared using the WOMAC score along with maximum distance walked as well as knee range of motion obtained prior to discharge. All data was obtained by a retrospective review of patient files. Results: The kinematic group required less augments, stems, and constrained inserts than the mechanical group and thinner polyethylene bearings. There were significant differences in the lateral distal femoral angle (LDFA) and the medial proximal tibial angle (MPTA) between the two groups (p<0.05). The mean WOMAC score obtained at discharge was better in the kinematic group as was mean knee flexion. At last follow up of 34 months for the kinematic group and 58 months for the mechanical group, no orthopedic complications or reoperations were recorded. Conclusion: Although this study has a small patient cohort, our results suggest that kinematic alignment for TKA after UKA revision is an attractive method. Further studies are warranted. PMID:27563365

  1. Environmental Stability and Residual Stresses in Zirconia Femoral Head for Total Hip Arthroplasty: In Vitro Aging versus Retrieval Studies.

    PubMed

    Arita, Masanori; Takahashi, Yasuhito; Pezzotti, Giuseppe; Shishido, Takaaki; Masaoka, Toshinori; Sano, Keiji; Yamamoto, Kengo

    2015-01-01

    The objective of this study was to compare the low temperature degradation (LTD) behavior of femoral heads made of 3Y-TZP as observed on retrievals with that induced in vitro upon prolonged exposures to a hydrothermal environment. The time-dependent evolution of tetragonal-to-monoclinic transformation and the related residual stresses were nondestructively monitored by Raman microspectroscopy. An increasing intensification of tensile and compressive stresses was detected with increasing hydrothermal aging duration in tetragonal and monoclinic phases, respectively. The dependence of monoclinic fraction upon exposure time was rationalized through the Mehl-Avrami-Johnson (MAJ) formalism in order to interpret the LTD process according to a two-step mechanism of formation and growth of monoclinic nuclei. In vitro results were compared to in vivo monoclinic contents in the same type of 3Y-TZP head retrievals after implantation periods of 1.6-16.6 y, also including literature data previously reported by other authors. One-hour exposure under the selected aging condition is estimated to correspond to in vivo exposures of 4 and 2 years according to ISO and ASTM criteria, respectively. A critical review of these two criteria according to the present analyses revealed that the ASTM simulation predicts more closely the in vivo results as compared to the ISO one. PMID:26146624

  2. Environmental Stability and Residual Stresses in Zirconia Femoral Head for Total Hip Arthroplasty: In Vitro Aging versus Retrieval Studies

    PubMed Central

    Arita, Masanori; Takahashi, Yasuhito; Pezzotti, Giuseppe; Shishido, Takaaki; Masaoka, Toshinori; Sano, Keiji; Yamamoto, Kengo

    2015-01-01

    The objective of this study was to compare the low temperature degradation (LTD) behavior of femoral heads made of 3Y-TZP as observed on retrievals with that induced in vitro upon prolonged exposures to a hydrothermal environment. The time-dependent evolution of tetragonal-to-monoclinic transformation and the related residual stresses were nondestructively monitored by Raman microspectroscopy. An increasing intensification of tensile and compressive stresses was detected with increasing hydrothermal aging duration in tetragonal and monoclinic phases, respectively. The dependence of monoclinic fraction upon exposure time was rationalized through the Mehl-Avrami-Johnson (MAJ) formalism in order to interpret the LTD process according to a two-step mechanism of formation and growth of monoclinic nuclei. In vitro results were compared to in vivo monoclinic contents in the same type of 3Y-TZP head retrievals after implantation periods of 1.6–16.6 y, also including literature data previously reported by other authors. One-hour exposure under the selected aging condition is estimated to correspond to in vivo exposures of 4 and 2 years according to ISO and ASTM criteria, respectively. A critical review of these two criteria according to the present analyses revealed that the ASTM simulation predicts more closely the in vivo results as compared to the ISO one. PMID:26146624

  3. Catastrophic failure of ceramic-polyethylene bearing total hip arthroplasty.

    PubMed

    Needham, Justin; Burns, Travis; Gerlinger, Tad

    2008-06-01

    Complications of ceramic-polyethylene bearing total hip arthroplasty (THA) include osteolysis, loosening, dislocation, and component failure. Catastrophic acetabular component failure involves severe damage to both the polyethylene liner and metal shell. This case study presents the first reported complete wear-through of the acetabular portion of a ceramic-polyethylene arthroplasty presenting as a dislocation and a review of the literature. In this study, a patient's alumina ceramic femoral head penetrated the polyethylene liner and titanium shell and presented as a dislocated THA. The contributing factors for this catastrophic failure include young patient age, high activity level, thin polyethylene liner, backside wear, component positioning, polyethylene sterilization with gamma irradiation in air, and lack of appropriate follow-up. Revision THA was performed without complications. PMID:18514888

  4. Total hip arthroplasty after rotational acetabular osteotomy.

    PubMed

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

    2015-03-01

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

  5. Trends in total knee arthroplasty implant utilization.

    PubMed

    Nguyen, Long-Co L; Lehil, Mandeep S; Bozic, Kevin J

    2015-05-01

    The incidence of total knee arthroplasty (TKA) has increased alongside our knowledge of knee physiology, kinematics, and technology resulting in an evolution of TKA implants. This study examines the trends in TKA implant utilization. Data was extracted from The Orthopedic Research Network to evaluate trends in level of constraint, fixed vs. mobile bearing, fixation, and type of polyethylene in primary TKAs. In 2012, 88% used cemented femoral and tibial implants, and 96% involved patellar resurfacing. 38% of implants were cruciate retaining, 53% posterior stabilized or condylar stabilized, 3% constrained. 91% were fixed-bearing, 7% mobile-bearing. 52% of tibial inserts were HXLPE. TKA implant trends demonstrate a preference for cemented femoral and tibial components, patellar resurfacing, fixed-bearing constructs, metal-backed tibial components, patellar resurfacing, and increased usage of HXLPE liners. PMID:25613663

  6. A Preliminary Feasibility Study On Seismic Monitoring Of Polymer Flooding

    NASA Astrophysics Data System (ADS)

    Nguyen, P. K.; Park, C.; Lim, B.; Nam, M.

    2012-12-01

    Polymer flooding using water with soluble polymers is an enhanced oil recovery technique, which intends to maximize oil-recovery sweep efficiency by minimizing fingering effects and as a result creating a smooth flood front; polymer flooding decreases the flow rates within high permeability zone while enhances those of lower permeabilities. Understanding of fluid fronts and saturations is critical to not only optimizing polymer flooding but also monitoring the efficiency. Polymer flooding monitoring can be made in single well scale with high-resolution wireline logging, in inter-well scale with tomography, and in reservoir scale with surface survey. For reservoir scale monitoring, this study makes a preliminary feasibility study based on constructing rock physics models (RPMs), which can bridge variations in reservoir parameters to the changes in seismic responses. For constructing RPMs, we change reservoir parameters with consideration of polymer flooding to a reservoir. Time-lapse seismic data for corresponding RPMs are simulated using a time-domain staggered-finite-difference modeling with implementation of a boundary condition of conventional perfect match layer. Analysis on time-lapse seismic data with respect to the changes in fluid front and saturation can give an insight on feasibility of surface seismic survey to polymer flooding. Acknowledgements: This work was supported by the Energy Efficiency & Resources of the Korea Institute of Energy Technology Evaluation and Planning (KETEP) grant funded by the Korea government Ministry of Knowledge Economy (No. 2012T100201588). Myung Jin Nam was partially supported by the National Research Foundation of Korea(NRF) grant funded by the Korea government(MEST) (No. 2011-0014684).

  7. Preliminary study of the CRRES magnetospheric barium releases

    NASA Technical Reports Server (NTRS)

    Huba, J. D.; Bernhardt, P. A.; Lyon, J. G.

    1992-01-01

    Preliminary theoretical and computational analyses of the Combined Release and Radiation Effects Satellite (CRRES) magnetospheric barium releases are presented. The focus of the studies is on the evolution of the diamagnetic cavity which is formed by the barium ions as they expand outward, and on the structuring of the density and magnetic field during the expansion phase of the releases. Two sets of simulation studies are discussed. The first set is based upon a 2D ideal MHD code and provides estimates of the time and length scales associated with the formation and collapse of the diamagnetic cavity. The second set uses a nonideal MHD code; specifically, the Hall term is included. This additional term is critical to the dynamics of sub-Alfvenic plasma expansions, such as the CRRES barium releases, because it leads to instability of the expanding plasma. Detailed simulations of the G4 and G10 releases were performed. In both cases the expanding plasma rapidly structured: the G4 release structured at time t less than about 3 s and developed scale sizes of about 1-2 km, while the G10 release structured at time t less than about 22 s and developed scale sizes of about 10-15 km. It is also found that the diamagnetic cavity size is reduced from those obtained from the ideal MHD results because of the structure. On the other hand, the structuring allows the formation of plasma blobs which appear to free stream across the magnetic field; thus, the barium plasma can propagate to larger distances traverse to the magnetic field than the case where no structuring occurs. Finally, a new normal mode of the system was discovered which may be excited at the leading edge of the expanding barium plasma.

  8. Nevada potential repository preliminary transportation strategy: Study 1

    SciTech Connect

    None,

    1995-04-01

    Limited feasible options exist when considering the shipment of spent nuclear fuel and high-level radioactive waste. These options are rail or truck; because of the weight associated with transportation casks (68.0 to 113.4 tonnes/75 to 125 tons), heavy-haul trucks are also considered. Yucca Mountain currently lacks rail service or an existing right-of-way for rail; it also lacks a dedicated highway suitable for heavy-haul trucks. Approximately 11,230 shipments by rail are planned from waste producer sites to Nevada, with an additional 1,041 shipments by legal-weight truck from four reactor sites not capable of upgrading for rail shipment. This study identifies the reasonable alternatives for waste transport to the potential repository site, describes the evaluation process performed to identify those alternatives, and discusses the reasons for elimination of transportation routes deemed to be not reasonable. The study concluded that heavy haul truck transportation is feasible-cost is very favorable when compared to rail-but route restrictions must be further evaluated. In addition to restrictions due to seasonal weather conditions, specific routes have additional restrictions, including no travel on holidays or weekends, and travel during daylight hours only. Further restrictions will be imposed by the U.S. Department of Transportation based on routing of radioactive materials by highway. Operation and maintenance costs for heavy-haul over a 24-year period, based on preliminary information, were calculated on an estimated operational cost of $15,000 per trip, with an estimated 468 trips per year average (11,230 total trips), for an estimated cost of $171 million to $173 million, depending on the route used. Because the initial costs and the total system life cycle costs of heavy-haul are approximately 50 percent lower than the lowest rail cost, this option will continue to be evaluated.

  9. Comparison of Head Center Position and Screw Fixation Options Between a Jumbo Cup and an Offset Center of Rotation Cup in Revision Total Hip Arthroplasty: A Computer Simulation Study.

    PubMed

    Faizan, Ahmad; Black, Brandon J; Fay, Brian D; Heffernan, Christopher D; Ries, Michael D

    2016-01-01

    Jumbo acetabular cups are commonly used in revision total hip arthroplasty (THA). A straightforward reaming technique is used which is similar to primary THA. However, jumbo cups may also be associated with hip center elevation, limited screw fixation options, and anterior soft tissue impingement. A partially truncated hemispherical shell was designed with an offset center of rotation, thick superior rim, and beveled anterior and superior rims as an alternative to a conventional jumbo cup. A three dimensional computer simulation was used to assess head center position and safe screw trajectories. Results of this in vitro study indicate that a modified hemispherical implant geometry can reduce head center elevation while permitting favorable screw fixation trajectories into the pelvis in comparison to a conventional jumbo cup.

  10. Preliminary study of volcano monitoring using geochemical composition of lichen

    NASA Astrophysics Data System (ADS)

    KUAN, S.

    2012-12-01

    Taipei City, the capital of Taiwan, is bounded with Tatun Volcano Group (TVG), which is not active since 200 ka. However, some evidences indicate that the latest explosion of volcanic ash was dated to 5-6 ka as well as TVG is so close to metropolis. The monitoring on TVG is crucial for crisis management. For monitoring TVG, changes of geochemical signal in some volcanic gases and hot springs are currently assessed by monthly sampling. The geochemistry of volcanic gas and hot spring represents a short-term condition on sampling time and is highly controlled by temperature and precipitation on the surface. A long-term average geochemistry will be very helpful to be compared with the results of volcanic gas and hot spring. A bioindicator not only has the ability to store geochemical compositions in their tissues but also has a wide geographical distribution. It is very suitable in this kind of study and lichen is one of the best bioindicators mainly because lichens grow slowly and have a large-scale dependence upon the environment for their nutrition, In TVG, the high SO2 content in the atmosphere results in the absence of fruticose lichen. On the contrary, crustos lichen is the most common species in the study area. For the preliminary analysis, one fruticose, four foliose and four crustos lichens were collected around the major emission centers of volcanic gas. According to the results of ICP-MS analysis, the abundances of heavy metals are generally in the order of Zn, Fe, Mn, Cu, Cr, Pb, Cd, Ni, V, Co and U. Factor analysis (FA) demonstrates that most of the metals show very high loadings in the first factor. This means that the fractionation of metals among different lichen species is minor and the geochemical compositions of lichen are possibly controlled by the same source (atmosphere). The second factor of FA includes Mn, Sr and Ba, which share the same oxidation state of +2 in acidic environment. This factor can describe the variation of Mn, Sr and Ba in the

  11. Adsorption of Roxarsone onto Drinking Water Treatment Residuals: Preliminary Studies

    NASA Astrophysics Data System (ADS)

    Salazar, J.; Sarkar, D.; Datta, R.; Sharma, S.

    2006-05-01

    above parameters were varied one at a time to study their effects on roxarsone adsorption. Desorption studies were carried out using 125 mg/L phosphorous at predetermined interval of time. In addition to analyzing for total As by an ICP-MS, aqueous speciation of As was performed using a coupled HPLC-ICP-MS system. Preliminary studies show significant roxarsone adsorption capacity of the WTRs.

  12. Infrared laser sealing of porcine tissues: preliminary in vivo studies

    NASA Astrophysics Data System (ADS)

    Cilip, Christopher M.; Hutchens, Thomas C.; Kerr, Duane; Latimer, Cassandra; Rosenbury, Sarah B.; Giglio, Nicholas C.; Schweinsberger, Gino R.; Perkins, William C.; Wilson, Christopher R.; Ward, Arlen; Nau, William H.; Fried, Nathaniel M.

    2015-02-01

    We are exploring infrared (IR) lasers as an alternative energy modality to radiofrequency (RF) and ultrasonic (US) devices intended to provide rapid surgical hemostasis with minimal collateral zones of thermal damage and tissue necrosis. Previously, a 1470-nm IR laser sealed and cut ex vivo porcine renal arteries of 1-8 mm in 2 s, yielding burst pressures < 1200 mmHg (compared to normal systolic blood pressure of 120 mmHg) and thermal coagulation zones < 3 mm (including the seal). This preliminary study describes in vivo testing of a laser probe in a porcine model. A prototype, fiber optic based handheld probe with vessel/tissue clasping mechanism was tested on blood vessels < 6 mm diameter using incident 1470-nm laser power of 35 W for 1-5 s. The probe was evaluated for hemostasis after sealing isolated and bundled vasculature of abdomen and hind leg, as well as liver and lung parenchyma. Sealed vessel samples were collected for histological analysis of lateral thermal damage. Hemostasis was achieved in 57 of 73 seals (78%). The probe consistently sealed vasculature in small bowel mesentery, mesometrium, and gastro splenic and epiploic regions. Seal performance was less consistent on hind leg vasculature including saphenous arteries and bundles and femoral and iliac arteries. Collagen denaturation averaged 1.6 mm in 8 samples excised for histologic examination. A handheld laser probe sealed porcine vessels in vivo. With further improvements in probe design and laser parameter optimization, IR lasers may provide an alternative to RF and US vessel sealing devices.

  13. A Preliminary Study of the Burgers Equation with Symbolic Computation

    NASA Astrophysics Data System (ADS)

    Derickson, Russell G.; Pielke, Roger A.

    2000-07-01

    A novel approach based on recursive symbolic computation is introduced for the approximate analytic solution of the Burgers equation. Once obtained, appropriate numerical values can be inserted into the symbolic solution to explore parametric variations. The solution is valid for both inviscid and viscous cases, covering the range of Reynolds number from 500 to infinity, whereas current direct numerical simulation (DNS) methods are limited to Reynolds numbers no greater than 4000. What further distinguishes the symbolic approach from numerical and traditional analytic techniques is the ability to reveal and examine direct nonlinear interactions between waves, including the interplay between inertia and viscosity. Thus, preliminary efforts suggest that symbolic computation may be quite effective in unveiling the “anatomy” of the myriad interactions that underlie turbulent behavior. However, due to the tendency of nonlinear symbolic operations to produce combinatorial explosion, future efforts will require the development of improved filtering processes to select and eliminate computations leading to negligible high order terms. Indeed, the initial symbolic computations present the character of turbulence as a problem in combinatorics. At present, results are limited in time evolution, but reveal the beginnings of the well-known “saw tooth” waveform that occurs in the inviscid case (i.e., Re=∞). Future efforts will explore more fully developed 1-D flows and investigate the potential to extend symbolic computations to 2-D and 3-D. Potential applications include the development of improved subgrid scale (SGS) parameterizations for large eddy simulation (LES) models, and studies that complement DNS in exploring fundamental aspects of turbulent flow behavior.

  14. Byssinosis in a textile factory in Cameroon: a preliminary study.

    PubMed Central

    Takam, J; Nemery, B

    1988-01-01

    To assess the risk of byssinosis in a cotton textile factory in Cameroon a preliminary study was conducted on a random sample of 125 men from production areas and 68 men from non-production areas. Symptoms were assessed by a questionnaire, which also included questions regarding sleep; peak expiratory flow rate (PEF) was measured with a miniature peak flow meter at the end of a working day and total dust concentrations were assessed by static and personal sampling with Casella dust samplers giving values of 6.4 +/- 2.6 mg/m3 (m +/- SD) in production areas and 1.7 +/- 0.7 mg/m3 in control areas. Exposed subjects had significantly more symptoms (particularly in smokers) and lower PEF values than controls (408 +/- 961/min v 468 +/- 701/min, p less than 0.001). Twenty three exposed subjects (18%) reported chest tightness on returning to work after the weekly break (compared with one control, p less than 0.01). Subjects with byssinosis had lower PEF values than those without chest tightness (356 +/- 501/min v 426 +/- 951/min, p less than 0.01), more chronic bronchitis (52% v 6%, p less than 0.001), they were more often smokers (61% v 31%, p less than 0.05), and came generally, though not exclusively, from the opening carding spinning department with the highest concentrations of total dust (8 +/- 2 mg/m3) and an estimated prevalence of byssinosis of 28%. There were no significant differences in sleep related symptoms between the exposed and controls, though the 23 subjects with byssinosis tended to report more snoring (48%), early morning headache (48%), and sleep improvement over the working week (44%) than all the other subjects (28%, 24%, and 24% respectively, p less than 0.1). PMID:3219305

  15. Total Ankle Arthroplasty: An Imaging Overview

    PubMed Central

    Kim, Da-Rae; Potter, Hollis G.; Li, Angela E.; Chun, Ka-Young; Jung, Yoon Young; Kim, Jin-Su; Young, Ki-Won

    2016-01-01

    With advances in implant technology, total ankle arthroplasty (TAA) has become an increasingly popular alternative to arthrodesis for the management of end-stage ankle arthritis. However, reports in the literature do not focus on the imaging features of TAA. Through a literature review, we demonstrate basic design features of the current ankle arthroplasty system, and the normal and abnormal postoperative imaging features associated with such devices. Pre- and postoperative evaluations of ankle arthroplasty mainly include radiography; in addition, computed tomography and magnetic resonance imaging provide further characterization of imaging abnormalities. Familiarization with multimodal imaging features of frequent procedural complications at various postoperative intervals is important in radiological practice. PMID:27134529

  16. Total Ankle Arthroplasty: An Imaging Overview.

    PubMed

    Kim, Da-Rae; Choi, Yun Sun; Potter, Hollis G; Li, Angela E; Chun, Ka-Young; Jung, Yoon Young; Kim, Jin-Su; Young, Ki-Won

    2016-01-01

    With advances in implant technology, total ankle arthroplasty (TAA) has become an increasingly popular alternative to arthrodesis for the management of end-stage ankle arthritis. However, reports in the literature do not focus on the imaging features of TAA. Through a literature review, we demonstrate basic design features of the current ankle arthroplasty system, and the normal and abnormal postoperative imaging features associated with such devices. Pre- and postoperative evaluations of ankle arthroplasty mainly include radiography; in addition, computed tomography and magnetic resonance imaging provide further characterization of imaging abnormalities. Familiarization with multimodal imaging features of frequent procedural complications at various postoperative intervals is important in radiological practice.

  17. Technology User Groups and Early Childhood Education: A Preliminary Study

    ERIC Educational Resources Information Center

    Parette, Howard P.; Hourcade, Jack J.; Blum, Craig; Watts, Emily H.; Stoner, Julia B.; Wojcik, Brian W.; Chrismore, Shannon B.

    2013-01-01

    This article presents a preliminary examination of the potential of Technology User Groups as a professional development venue for early childhood education professionals in developing operational and functional competence in using hardware and software components of a Technology toolkit. Technology user groups are composed of varying numbers of…

  18. Preliminary design study of astronomical detector cooling system

    NASA Technical Reports Server (NTRS)

    Norman, R. H.

    1976-01-01

    The preliminary design of an astronomical detector cooling system for possible use in the NASA C-141 Airborne Infrared Observatory is presented. The system consists of the following elements: supercritical helium tank, Joule-Thomson supply gas conditioner, Joule-Thomson expander (JTX), optical cavity dewar, optical cavity temperature controller, adjustable J-T discharge gas pressure controller, and vacuum pump.

  19. A Preliminary Outcome Study of Response Ability Pathways Training

    ERIC Educational Resources Information Center

    Forthun, Larry F.; McCombie, Jeff W.

    2007-01-01

    Approximately 68 classroom teachers participated in a preliminary evaluation of Response Ability Pathways (RAP), a reclaiming training course for adults who work with children and youth. RAP offers basic training in the Circle of Courage Model and provides participants with general strategies for assisting youth who are experiencing challenges.…

  20. Thromboembolism Prophylaxis in Hip Arthroplasty: Routine and High Risk Patients.

    PubMed

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

    2015-12-01

    This study's purpose was to present the use of a risk stratification protocol in which "routine" risk patients receive a mobile compression device with aspirin and "high" risk patients receive warfarin for thromboprophylaxis after hip arthroplasty. 1859 hip arthroplasty patients were prospectively enrolled (1402 routine risk--75.4%, 457 high risk--24.6%). The cumulative rate of venous thromboembolism events was 0.5% in the routine versus 0.5% in the high-risk cohort within 6weeks postoperatively (P=1.00). Patients in the routine risk cohort had a lower rate of major bleeding (0.5% versus 2.0%, P=0.006) and wound complications (0.2% versus 1.2%, P=0.01). Use of our risk stratification protocol allowed the avoidance of more aggressive anticoagulation in 75% of patients while achieving a low overall incidence of symptomatic VTE. PMID:26182980

  1. Establishing Realistic Patient Expectations Following Total Knee Arthroplasty.

    PubMed

    Husain, Adeel; Lee, Gwo-Chin

    2015-12-01

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

  2. It’s not just a knee, but a whole life: A qualitative descriptive study on patients’ experiences of living with knee osteoarthritis and their expectations for knee arthroplasty

    PubMed Central

    Nyvang, Josefina; Hedström, Margareta; Gleissman, Sissel Andreassen

    2016-01-01

    Aim Knee arthroplasties are an increasingly common treatment for osteoarthritis (OA) and the main indication is pain. Previous research states, however, that 15–20% of the operated patients are dissatisfied and 20–30% have persistent pain after surgery. This study is aimed at describing patients’ experiences of living with knee OA when scheduled for surgery and further their expectations for future life after surgery. Methods We interviewed 12 patients with knee OA scheduled for arthroplasty, using semi-structured qualitative interviews. The interviews were recorded and transcribed verbatim and analyzed using qualitative thematic analysis. Findings Three categories were formulated with an overriding theme: “It's not just a knee, but a whole life.” The three categories were “Change from their earlier lives,” “Coping with knee problems,” and “Ultimate decision to undergo surgery.” The main finding was that knee OA affects the whole body and self, ultimately affecting the patients’ lives on many levels. Further findings were that knee OA was considered to be the central focus in the participants’ lives, which limited their level of activity, their ability to function as desired, their quality of life, and their mental well-being. Although surgery was considered to be the only solution, the expectations regarding the outcome differed. Conclusions The participants were forced to change how they previously had lived their lives resulting in a feeling of loss. Thus, the experienced loss and expectations for future life must be put into the context of the individual's own personality and be taken into account when treating individuals with knee OA. The experience of living with knee OA largely varies between individuals. This mandates that patients’ assessment should be considered on individual basis with regard to each patient. PMID:27036130

  3. Validation of primary metal-on-metal hip arthroplasties on the National Joint Registry for England, Wales and Northern Ireland using data from the London Implant Retrieval Centre: a study using the NJR dataset.

    PubMed

    Sabah, S A; Henckel, J; Cook, E; Whittaker, R; Hothi, H; Pappas, Y; Blunn, G; Skinner, J A; Hart, A J

    2015-01-01

    Arthroplasty registries are important for the surveillance of joint replacements and the evaluation of outcome. Independent validation of registry data ensures high quality. The ability for orthopaedic implant retrieval centres to validate registry data is not known. We analysed data from the National Joint Registry for England, Wales and Northern Ireland (NJR) for primary metal-on-metal hip arthroplasties performed between 2003 and 2013. Records were linked to the London Implant Retrieval Centre (RC) for validation. A total of 67,045 procedures on the NJR and 782 revised pairs of components from the RC were included. We were able to link 476 procedures (60.9%) recorded with the RC to the NJR successfully. However, 306 procedures (39.1%) could not be linked. The outcome recorded by the NJR (as either revised, unrevised or death) for a primary procedure was incorrect in 79 linked cases (16.6%). The rate of registry-retrieval linkage and correct assignment of outcome code improved over time. The rates of error for component reference numbers on the NJR were as follows: femoral head category number 14/229 (5.0%); femoral head batch number 13/232 (5.3%); acetabular component category number 2/293 (0.7%) and acetabular component batch number 24/347 (6.5%). Registry-retrieval linkage provided a novel means for the validation of data, particularly for component fields. This study suggests that NJR reports may underestimate rates of revision for many types of metal-on-metal hip replacement. This is topical given the increasing scope for NJR data. We recommend a system for continuous independent evaluation of the quality and validity of NJR data.

  4. Patellar fractures following total knee arthroplasty: a review.

    PubMed

    Sayeed, Siraj A; Naziri, Qais; Patel, Yashika D; Boylan, Matthew R; Issa, Kimona; Mont, Michael A

    2013-01-01

    There are several periprosthetic complications associated with total knee arthroplasty, with femoral fracture as the most common and patellar fractures as the second most common. Patellar fractures are challenging complications that occur almost exclusively on the resurfaced patellae, although unresurfaced patellar fractures have been reported in literature. The purpose of this study is to describe the anatomy of the patella, the etiology of patellar fractures, and strategies to treat and manage these fractures following knee arthroplasty. The vascular supply to the patella may be compromised during total knee arthroplasty and special care must be taken to preserve it. Vessel injury may result in further complications, most notably avascular necrosis with subsequent fracture. Other patient-, surgical-, and prosthetic-related factors can contribute to increased risk of patellar fracture. Patellar fractures are classified into three types. Type I fractures have an intact extensor mechanism with a stable implant. Type II fractures have a complete disruption of the extensor mechanism with or without a stable implant. Type III fractures, which are further subclassified into types IIIa and IIIb, have an intact extensor mechanism but a loose patellar component. While type IIIa fractures have reasonable remaining bone stock, type IIIb fractures have poor bone stock. Type I patellar fractures may be best managed nonoperatively, but types II and III patellar fractures often necessitate surgical intervention. Patellectomy should be reserved for comminuted fractures, as well as fractures in patients with poor bone stock. Larger prospective randomized studies are necessary to better evaluate the treatment algorithm for patellar fractures following total knee arthroplasty.

  5. Patient and health professional views on rehabilitation practices and outcomes following total hip and knee arthroplasty for osteoarthritis:a focus group study

    PubMed Central

    2010-01-01

    Background There is worldwide variation in rehabilitation practices after total hip arthroplasty (THA) and total knee arthroplasty (TKA) and no agreement on which interventions will lead to optimal short and long term patient outcomes. As a first step in the development of clinical practice guidelines for post-acute rehabilitation after THA and TKA, we explored experiences and attitudes about rehabilitation practices and outcomes in groups of individuals identified as key stakeholders. Methods Separate focus groups and interviews were conducted with patients (THA or TKA within past year) and three health professional groups: allied health professionals (AHPs), orthopaedic surgeons, and other physicians, in Canada and the United States. Pairs of moderators led the focus groups using a standardized discussion guide. Discussions were audiotaped and transcribed verbatim. A content analysis within and across groups identified key themes. Results Eleven focus groups and eight interviews took place in six sites. Patients (n = 32) varied in age, stage of recovery, and surgical and rehabilitation experiences. Health professionals (n = 44) represented a range of disciplines, practice settings and years of experience. Six key themes emerged: 1) Let's talk (issues related to patient-health professional and inter-professional communication); 2) Expecting the unexpected (observations about unanticipated recovery experiences); 3) It's attitude that counts (the importance of the patient's positive attitude and participation in recovery); 4) It takes all kinds of support (along the continuum of care); 5) Barriers to recovery (at patient, provider and system levels), and 6) Back to normal (reflecting diversity of expected outcomes). Patients offered different, but overlapping views compared to health professionals regarding rehabilitation practices and outcomes following THA and TKA. Conclusion Results will inform subsequent phases of guideline development and ensure stakeholders

  6. Stiffness after total knee arthroplasty.

    PubMed

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

    2015-04-01

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

  7. Total-hip arthroplasty: Periprosthetic indium-111-labeled leukocyte activity and complementary technetium-99m-sulfur colloid imaging in suspected infection

    SciTech Connect

    Palestro, C.J.; Kim, C.K.; Swyer, A.J.; Capozzi, J.D.; Solomon, R.W.; Goldsmith, S.J. )

    1990-12-01

    Indium-111-labeled leukocyte images of 92 cemented total-hip arthroplasties were correlated with final diagnoses. Prostheses were divided into four zones: head (including acetabulum), trochanter, shaft, and tip. The presence (or absence) and intensity of activity in each zone was noted, and compared to the corresponding contralateral zone. Though present in all 23 infected arthroplasties, periprosthetic activity was also present in 77% of uninfected arthroplasties, and was greater than the contralateral zone 51% of the time. When analyzed by zone, head zone activity was the best criterion for infection (87% sensitivity, 94% specificity, 92% accuracy). Fifty of the arthroplasties were studied with combined labeled leukocyte/sulfur colloid imaging. Using incongruence of images as the criterion for infection, the sensitivity, specificity, and accuracy of the study were 100%, 97%, and 98%, respectively. While variable periprosthetic activity makes labeled leukocyte imaging alone unreliable for diagnosing hip arthroplasty infection, the addition of sulfur colloid imaging results in a highly accurate diagnostic procedure.

  8. Intraoperative Fluoroscopy Improves Component Position During Anterior Hip Arthroplasty.

    PubMed

    Jennings, John D; Iorio, Justin; Kleiner, Matthew T; Gaughan, John P; Star, Andrew M

    2015-11-01

    The goal of this retrospective review was to determine whether fluoroscopic guidance improves acetabular cup abduction and anteversion alignment during anterior total hip arthroplasty. The authors retrospectively reviewed 199 patients (fluoroscopy group, 98; nonfluoroscopy group, 101) who underwent anterior total hip arthroplasty at a single center with and without C-arm fluoroscopy guidance. Included in the study were patients of any age who underwent primary anterior approach total hip arthroplasty performed by a single surgeon, with 6-month postoperative anteroposterior pelvis radiographs. Acetabular cup abduction and anteversion angles were measured and compared between groups. Mean acetabular cup abduction and anteversion angles were 43.4° (range, 26.0°-57.4°) and 23.1° (range, 17°-28°), respectively, in the fluoroscopy group. Mean abduction and anteversion angles were 45.9° (range, 29.7°-61.3°) and 23.1° (range, 17°-28°), respectively, after anterior total hip arthroplasty without the use of C-arm guidance (nonfluoroscopy group). The use of fluoroscopy was associated with a statistically significant difference in cup abduction (P=.002) but no statistically significant difference in anteversion angles. In the fluoroscopy group, 80% of implants were within the combined safe zone compared with 63% in the nonfluoroscopy group. A significantly higher percentage of both acetabular cup abduction angles and combined anteversion and abduction angles were in the safe zone in the fluoroscopy group. Fluoroscopy is not required for proper anteversion placement of acetabular components, but it may increase ideal safe zone placement of components.

  9. Variations in ESR and CRP in total knee arthroplasty and total hip arthroplasty in Iranian patients from 2009 to 2011

    PubMed Central

    Nazem, Khalilolah; Motififard, Mehdi; Yousefian, Mehdi

    2016-01-01

    Background: Implantation of joint prosthesis, either in the knee or in the hip, may cause some problems such as an infection, so that a timely treatment is essential. In this respect, discovering a marker detecting the incidence of an infection is one of the requirements of arthroplasty. The present study was conducted to determine variations of two markers in arthroplasty and infection incidence in Iranian patients. Materials and Methods: This prospective study was carried out in Isfahan’s educational treatment centers from 2009 to 2011 on patients undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA) surgical operations. The erythrocyte sedimentation rate (ESR) was measured by Sed rate device (Lena) and C-reactive protein (CRP) by autoanalyzer device (Erba) with the unit of ng/dL. The patients underwent ESR and CRP tests the day before operation, the day of operation, and 1, 2, 5, and 15 days and 1, 3, 6, and 12 months after operation. Results: Mean ESR increased during the first 5 days then decreased gradually lasting for 3 months. After 1 year it increased to a level higher than before the operation. The variations in ESR values were 19.1 ± 12.9 before the operation and 21.14 ± 10.8 after 1 year with significant difference (P < 0.001). The level of CRP had an upward trend from the first day after operation and reached its maximum on the second day, then had a downward trend up to 1 month after the operation; however, it did not reach its preoperative level during 1 year. Conclusion: ESR and CRP and their variations can be suitable factors to detect probable infections in patients undergoing TKA and THA operations.

  10. Variations in ESR and CRP in total knee arthroplasty and total hip arthroplasty in Iranian patients from 2009 to 2011

    PubMed Central

    Nazem, Khalilolah; Motififard, Mehdi; Yousefian, Mehdi

    2016-01-01

    Background: Implantation of joint prosthesis, either in the knee or in the hip, may cause some problems such as an infection, so that a timely treatment is essential. In this respect, discovering a marker detecting the incidence of an infection is one of the requirements of arthroplasty. The present study was conducted to determine variations of two markers in arthroplasty and infection incidence in Iranian patients. Materials and Methods: This prospective study was carried out in Isfahan’s educational treatment centers from 2009 to 2011 on patients undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA) surgical operations. The erythrocyte sedimentation rate (ESR) was measured by Sed rate device (Lena) and C-reactive protein (CRP) by autoanalyzer device (Erba) with the unit of ng/dL. The patients underwent ESR and CRP tests the day before operation, the day of operation, and 1, 2, 5, and 15 days and 1, 3, 6, and 12 months after operation. Results: Mean ESR increased during the first 5 days then decreased gradually lasting for 3 months. After 1 year it increased to a level higher than before the operation. The variations in ESR values were 19.1 ± 12.9 before the operation and 21.14 ± 10.8 after 1 year with significant difference (P < 0.001). The level of CRP had an upward trend from the first day after operation and reached its maximum on the second day, then had a downward trend up to 1 month after the operation; however, it did not reach its preoperative level during 1 year. Conclusion: ESR and CRP and their variations can be suitable factors to detect probable infections in patients undergoing TKA and THA operations. PMID:27656617

  11. Preliminary design studies for the DESCARTES and CIDER codes

    SciTech Connect

    Eslinger, P.W.; Miley, T.B.; Ouderkirk, S.J.; Nichols, W.E.

    1992-12-01

    The Hanford Environmental Dose Reconstruction (HEDR) project is developing several computer codes to model the release and transport of radionuclides into the environment. This preliminary design addresses two of these codes: Dynamic Estimates of Concentrations and Radionuclides in Terrestrial Environments (DESCARTES) and Calculation of Individual Doses from Environmental Radionuclides (CIDER). The DESCARTES code will be used to estimate the concentration of radionuclides in environmental pathways, given the output of the air transport code HATCHET. The CIDER code will use information provided by DESCARTES to estimate the dose received by an individual. This document reports on preliminary design work performed by the code development team to determine if the requirements could be met for Descartes and CIDER. The document contains three major sections: (i) a data flow diagram and discussion for DESCARTES, (ii) a data flow diagram and discussion for CIDER, and (iii) a series of brief statements regarding the design approach required to address each code requirement.

  12. Preliminary experimental study of a carbon fiber array cathode

    NASA Astrophysics Data System (ADS)

    Li, An-kun; Fan, Yu-wei

    2016-08-01

    The preliminary experimental results of a carbon fiber array cathode for the magnetically insulated transmission line oscillator (MILO) operations are reported. When the diode voltage and diode current were 480 kV and 44 kA, respectively, high-power microwaves with a peak power of about 3 GW and a pulse duration of about 60 ns were obtained in a MILO device with the carbon fiber array cathode. The preliminary experimental results show that the shot-to-shot reproducibility of the diode current and the microwave power is stable until 700 shots. No obvious damage or deterioration can be observed in the carbon fiber surface morphology after 700 shots. Moreover, the cathode performance has no observable deterioration after 700 shots. In conclusion, the maintain-free lifetime of the carbon fiber array cathode is more than 700 shots. In this way, this carbon fiber array cathode offers a potential replacement for the existing velvet cathode.

  13. Preliminary Fatigue Studies on Aluminum Alloy Aircraft Engines

    NASA Technical Reports Server (NTRS)

    1938-01-01

    Preliminary information on the complex subject of the fatigue strength of fabricated structural members for aircraft is presented in the test results obtained on several different types of airship girders subjected to axial tension and compression in a resonance fatigue machine. A description of this machine as well as numerous photographs of the fatigue failures are given. There is also presented an extended bibliography on the subject of fatigue strength.

  14. (D, L) polylactide microspheres as embolic agent. A preliminary study.

    PubMed

    Flandroy, P; Grandfils, C; Collignon, J; Thibaut, A; Nihant, N; Barbette, S; Jerome, R; Teyssie, P

    1990-01-01

    Owing to their shape, accurately calibrated microspheres appear to be very suitable material for distal embolization. Moreover, the biocompatible (D, L) polyactide (PLA) microspheres possess two other valuable advantages: easy adjustment of their biodegradation rate, and incorporation of chemotherapeutic agents during their production. The authors describe the preparation of these (D, L) PLA microspheres and their clinical applications as a preliminary step to arterial chemoembolization. PMID:2234391

  15. Postoperative pain following primary lower limb arthroplasty and enhanced recovery pathway

    PubMed Central

    Wagstaff, KJ; Sanghera, S; Kerry, RM

    2014-01-01

    Introduction Enhanced recovery is a concept that has become increasingly popular for arthroplasty surgery over the last ten years. This study was designed to assess the analgesia requirements, pain levels and time to discharge for patients having primary arthroplasty in the enhanced recovery pathway. Methods A multidisciplinary prospective cohort study was carried out between January 2012 and March 2012. Data were collected for patients undergoing primary arthroplasty in one hospital during this time. Details of anaesthesia, local infiltration, additional medications and analgesia were recorded. A visual analogue scale pain score was obtained from each patient at time of mobilisation on days 0, 1, 2 and 3 postoperatively. Results Ninety-six patients were included in the study. Of these, 34 underwent total hip arthroplasty and 62 total knee arthroplasty (TKA). Pain was the greatest contributor for delayed discharge in TKA patients. The patients who had TKA and did not receive non-steroidal anti-inflammatory drugs (NSAIDs) had significantly higher pain scores (day 0, p<0.01; day 1, p<0.001; day 2, p<0.01) and significantly increased opiate demands compared with those patients who did receive NSAIDs. Conclusions There are unacceptably high pain scores in patients undergoing TKA without the use of NSAIDs. There should be focused intervention with this group of patients to improve their pain scores and reduce their length of stay. PMID:24780024

  16. [Recovery from total knee arthroplasty through continuous passive motion].

    PubMed

    Sánchez Mayo, B; Rodríguez-Mansilla, J; González Sánchez, B

    2015-01-01

    The purpose of this study was to know the effects of continuous passive mobilization in patients who underwent total knee arthroplasty. A search strategy was developed to retrieve all clinical trials, written in English and/or Spanish, published in the electronic search databases PubMed, Cochrane Library Plus, Dialnet, CSIC and PEDro. The inclusion criteria were: clinical trials published from January 2000 until November 2014 in English or Spanish. Out of 537 clinical trials that were potentially relevant, a total of 12 were included in this review. The evaluation of 1,153 patients shows that there is no significant difference in improving the range of the joint, pain, balance, motion, healing and hospital stay using continuous passive mobilization against the regular physiotherapy treatment for total knee arthroplasty. The application of continuous passive mobilization in the long-term does not provide any benefit in terms of the breadth of the range of the joint, pain and improvement of standing and motion in comparison with conventional postoperative physiotherapy treatment in total knee arthroplasty. In the short term an improvement is obtained in the range of joint motion in knee flexion.

  17. Bone anatomy and rotational alignment in total knee arthroplasty.

    PubMed

    Uehara, K; Kadoya, Y; Kobayashi, A; Ohashi, H; Yamano, Y

    2002-09-01

    The purpose of the current study was to investigate the bone anatomy in determining the rotational alignment in total knee arthroplasty using computed tomography. Axial images of 109 knees in 83 patients with varus osteoarthritis who had total knee arthroplasty were analyzed. On the images of the distal femur and the proximal tibia, a baseline for the anteroposterior axis of each component was drawn based on the epicondylar axis for the femur and the medial (1/3) of the tibial tuberosity for the tibia. The angle between these two lines was analyzed as the rotational mismatch between the components when they were aligned to the anatomic landmarks of each bone. Fifty-four knees (49.5%) had an angle of 5 degrees or greater and 13 knees (11.9%) had an angle of 10 degrees or greater. There was a tendency to align the tibial component in external rotation relative to the femoral component. The results indicated that the landmarks of each bone were the intrinsic cause of the rotational mismatch in knees with varus osteoarthritis. Surgeons doing total knee arthroplasties should be aware of this and check the rotational mismatch between the components. When it is present, the tibial component should be realigned to match the femoral component rotation to minimize problems caused by the mismatch.

  18. Prevalence of osteoporosis in patients awaiting total hip arthroplasty

    PubMed Central

    Domingues, Vitor Rodrigues; de Campos, Gustavo Constantino; Plapler, Pérola Grimberg; de Rezende, Márcia Uchôa

    2015-01-01

    Objective: To evaluate the prevalence of osteoporosis in patients awaiting total hip arthroplasty. Method: Twenty-nine patients diagnosed with hip osteoarthritis awaiting primary total arthroplasty of the hip answered WOMAC questionnaire, VAS and questions about habits, osteoporosis and related diseases. Bone mineral densitometry of the lumbar spine and hips and laboratory tests (complete blood count and examination of calcium metabolism) were performed. Weight and height were measured to calculate body mass index (BMI). The evaluated quantitative characteristics were compared between patients with and without osteoporosis using the Mann-Whitney tests. Results: Thirteen men and 16 women with a mean age of 61.5 years old, WOMAC 51.4; EVA 6.4 and BMI 27.6 were evaluated. The prevalence of osteoporosis was 20.7%, and 37.9% had osteopenia. Patients with osteoporosis were older than patients without osteoporosis (p=0.006). The mean bone mineral density of the femoral neck without hip osteoarthritis was lower than the affected side (p=0.007). Thirty-five percent of patients did not know what osteoporosis is. Of these, 30% had osteopenia or osteoporosis. Conclusion: osteoarthritis and osteoporosis may coexist and the population waiting for total hip arthroplasty should be considered at risk for the presence of osteoporosis. Level of Evidence III, Observational Study. PMID:26327793

  19. [Recovery from total knee arthroplasty through continuous passive motion].

    PubMed

    Sánchez Mayo, B; Rodríguez-Mansilla, J; González Sánchez, B

    2015-01-01

    The purpose of this study was to know the effects of continuous passive mobilization in patients who underwent total knee arthroplasty. A search strategy was developed to retrieve all clinical trials, written in English and/or Spanish, published in the electronic search databases PubMed, Cochrane Library Plus, Dialnet, CSIC and PEDro. The inclusion criteria were: clinical trials published from January 2000 until November 2014 in English or Spanish. Out of 537 clinical trials that were potentially relevant, a total of 12 were included in this review. The evaluation of 1,153 patients shows that there is no significant difference in improving the range of the joint, pain, balance, motion, healing and hospital stay using continuous passive mobilization against the regular physiotherapy treatment for total knee arthroplasty. The application of continuous passive mobilization in the long-term does not provide any benefit in terms of the breadth of the range of the joint, pain and improvement of standing and motion in comparison with conventional postoperative physiotherapy treatment in total knee arthroplasty. In the short term an improvement is obtained in the range of joint motion in knee flexion. PMID:26486536

  20. Preliminary decommissioning study reports. Volume 5, Molten Salt Reactor Experiment

    SciTech Connect

    Peretz, F.J.

    1984-09-01

    The Molten Salt Reactor Experiment (MSRE) is one of approximately 76 facilities currently managed by the ORNL Surplus Facilities Management Program (SFMP). This program, as part of the DOE national SFMP, is responsible for the maintenance and surveillance and the final decommissioning of radioactively-contaminated surplus ORNL facilities. A long range planning effort is being conducted that will outline the scope and objectives of the ORNL program and establish decommissioning priorities based on health and safety concerns, budget constraints, and other programmatic constraints. In support of this SFMP planning activity, preliminary engineering assessments are being conducted for each of the ORNL surplus facilities currently managed under the program. These efforts, in general, are designed to: (1) provide an initial assessment of the potential decommissioning alternatives; (2) choose a preferred alternative and provide a justification for that choice, and (3) provide a preliminary description of the decommissioning plan, including cost and schedule estimates. Because of several issues which cannot be evaluated quantitatively at this time, this report on the MSRE does not select a ``most probable decommissioning mode`` but rather discusses the issues and representative alternatives for disposal of the MSRE fuel salts and decommissioning of the facility. A budget and schedule representative of the types of activities likely to be required is also suggested for preliminary use in the SFMP Long Range Plan.

  1. A preliminary study of the Ria de Aveiro plume dispersal

    NASA Astrophysics Data System (ADS)

    Mendes, R.; Sousa, M. C.; Vaz, N.; deCastro, M.; Dias, J. M.

    2012-04-01

    Over the last years several studies have been performed about the hydrodynamic and the water properties transport in the Ria de Aveiro lagoon, but none of them had the focus on the dispersal of the lagoon plume into the adjacent Atlantic Ocean. This buoyant plume injects less dense water in to the ocean during the ebbing, which penetrates onto the coastal zone generating an offshore movement in the surface layer. The structure of the estuarine plume is usually characterized by a buoyant bulge, propagating radially form the lagoon inlet. Its shape depends on several factors: density differences between ocean and estuarine water; bathymetric changes and meteorological parameters variability, in particular of the wind direction and intensity. The main objective of this study is to perform a preliminary study of the Ria de Aveiro estuarine plume, as well as its qualitative assessment during extreme river discharges conditions (maximum and minimum) and also a typical estuarine inflow/outflow value for the Winter (January). A baroclinic finite volume numerical model, MOHID was implemented separately to the Ria de Aveiro and to the adjacent coast. The lagoon application was performed in a 2D mode, and has the purpose of quantifying the flow (and its properties) that the Ria de Aveiro injects into the ocean. The coastal application consisted in a numerical implementation using a three level baroclinic nesting model. The model domain includes the whole Iberian Peninsula using a realistic coastline and bottom topography. Initial ocean stratification and tide are from the MERCATOR solution and FES Global tidal solution, respectively. The hourly lagoon discharge, previously calculated through the model runs of the Ria de Aveiro estuarine model, was imposed in the lagoon mouth location of the coastal application, in order to allow the study of the estuarine plume dynamics. The model results were compared with satellite images, to assess the models performance. For an intense

  2. Effect of body mass index on functional outcomes following arthroplasty procedures

    PubMed Central

    Polat, Gokhan; Ceylan, Hasan Huseyin; Sayar, Safak; Kucukdurmaz, Fatih; Erdil, Mehmet; Tuncay, Ibrahim

    2015-01-01

    AIM: To evaluate the body mass index (BMI) change in arthroplasty patients and its impact on the patients’ functional results. METHODS: Between October 2010 and May 2013, 606 patients who were operated due to gonarthrosis, coxarthrosis, aseptic loosening of the total knee and hip prosthesis were evaluated prospectively. Patients were operated by three surgeons in three medical centers. Patients who were between 30-90 years of age and who were underwent total knee arthroplasty, total hip arthroplasty, revision knee arthroplasty, or revision hip arthroplasty were included in the study. We excluded the patients who cannot tolerate our standard postoperative rehabilitation program. Additionally, patients who had systemic inflammatory diseases, diabetes mellitus, or endochrinopathies were excluded from the study. The remaining 513 patients comprised our study group. Preoperative functional joint scores, height, weight and BMI of all patients were recorded. We used the Knee Society Score (KSS) for knee and Harris Hip Score (HHS) for hip patients. Postoperative functional scores were measured at 1st, 6th and 12th months and recorded separately at outpatient visits. RESULTS: The mean age of the patients was 64.7 (range: 30-90) years (207 males/306 females) and the mean follow-up duration was 14.3 (range: 12-26) mo. We found that arthroplasty patients had weight gain and had an increase in BMI at the postoperative 1st, 6th and 12th months. The mean BMI of the patients was 27.7 preoperatively, 27.8 at the postoperative 1st month, 28.1 at the 6th month and 28.6 at the 12th month (P < 0.01). At the last visit, the mean postoperative HHS of the hip arthroplasty patients was 82.2 ± 7.12 (preoperatively, 52.3; 1st month, 78.2; 6th month, 81.1; 12th month, 82.2), and the mean KSS of the knee arthroplasty patients was 79.3 ± 4.31 (preoperatively, 35.8; 1st month, 75.2; 6th month, 79.1; 12th month, 79.3). Worse functional results were noted in the patients who had a BMI increase

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

    PubMed

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

    2014-09-01

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

  4. New Joints, Same Old Weight: Weight Changes After Total Hip and Knee Arthroplasty.

    PubMed

    Hurwit, Daniel J; Trehan, Samir K; Cross, Michael B

    2016-07-01

    Obesity is a well-known risk factor for postoperative complications following total joint arthroplasty. However, because the operation is often successful, orthopedic surgeons continue to operate on obese individuals, and many surgeons do so under the assumption that patients will lose weight after they are able to walk and exercise without pain. In this article, we review a recent study by Ast et al., who performed a retrospective review, using a single-center institutional registry, to determine (1) whether patients do actually lose weight after total hip and/or total knee arthroplasty, (2) whether there are predictors of postoperative weight change, and (3) whether postoperative weight changes affect patient-reported clinical outcomes. The principle conclusion was that most patients maintained their body mass index (BMI) after total hip and total knee arthroplasty (73 and 69%, respectively). However, patients undergoing total knee arthroplasty, patients who had a higher preoperative BMI, and female patients were more likely to lose weight postoperatively. When examined in the context of the current literature, this study provides valuable information for the preoperative counseling of total joint arthroplasty candidates, especially in the setting of obesity. PMID:27385952

  5. Perioperative Pulmonary Circulatory Changes During Bilateral Total Hip Arthroplasty Under Regional Anesthesia

    PubMed Central

    Memtsoudis, Stavros G.; Salvati, Eduardo A.; Go, George; Ma, Yan; Sharrock, Nigel E.

    2010-01-01

    Background and Objectives The transient and rarely clinically relevant effect of bone and cement embolization during unilateral joint arthroplasty is a known phenomenon. However, available studies do not address events surrounding bilateral total hip arthroplasties, during which embolic load is presumably doubled. To elucidate events surrounding this increasingly utilized procedure and assess the effect on the pulmonary hemodynamics in the intra- and postoperative period, we studied 24 subjects undergoing cemented bilateral total hip arthroplasty during the same anesthetic session. Materials Twenty four patients without previous pulmonary history undergoing cemented bilateral total hip arthroplasty under controlled epidural hypotension were enrolled. Pulmonary artery catheters were inserted and hemodynamic variables were recorded at baseline, 5 minutes after the implantation of each hip joint, 1 hour and 1 day postoperatively. Mixed venous blood gases and complete blood counts were analyzed at every time point. Results An increase in pulmonary vascular resistance was observed after the second but not the first hip implantation when compared to values at incision. Pulmonary vascular resistance remained elevated 1 hour postoperatively. Pulmonary artery pressures were significantly elevated on post operative day 1 compared to baseline values. The white blood cell count increased in response to the second hip implantation but not the first compared to incision. Conclusion The embolization of material during bilateral total hip arthroplasty is associated with prolonged increases in pulmonary artery pressures and vascular resistance, particularly after the second side. The performance of bilateral procedures should be cautiously considered in patients with diseases suggesting decreased right ventricular reserve. PMID:20814281

  6. Lubrication regimes in lumbar total disc arthroplasty.

    PubMed

    Shaheen, A; Shepherd, D E T

    2007-08-01

    A number of total disc arthroplasty devices have been developed. Some concern has been expressed that wear may be a potential failure mode for these devices, as has been seen with hip arthroplasty. The aim of this paper was to investigate the lubrication regimes that occur in lumbar total disc arthroplasty devices. The disc arthroplasty was modelled as a ball-and-socket joint. Elastohydrodynamic lubrication theory was used to calculate the minimum film thickness of the fluid between the bearing surfaces. The lubrication regime was then determined for different material combinations, size of implant, and trunk velocity. Disc arthroplasties with a metal-polymer or metal-metal material combination operate with a boundary lubrication regime. A ceramic-ceramic material combination has the potential to operate with fluid-film lubrication. Disc arthroplasties with a metal-polymer or metal-metal material combination are likely to generate wear debris. In future, it is worth considering a ceramic-ceramic material combination as this is likely to reduce wear.

  7. MR Imaging of Knee Arthroplasty Implants

    PubMed Central

    Fritz, Jan; Lurie, Brett

    2015-01-01

    Primary total knee arthroplasty is a highly effective treatment that relieves pain and improves joint function in a large percentage of patients. Despite an initially satisfactory surgical outcome, pain, dysfunction, and implant failure can occur over time. Identifying the etiology of complications is vital for appropriate management and proper timing of revision. Due to the increasing number of knee arthroplasties performed and decreasing patient age at implantation, there is a demand for accurate diagnosis to determine appropriate treatment of symptomatic joints following knee arthroplasty, and for monitoring of patients at risk. Magnetic resonance (MR) imaging allows for comprehensive imaging evaluation of the tissues surrounding knee arthroplasty implants with metallic components, including the polyethylene components. Optimized conventional and advanced pulse sequences can result in substantial metallic artifact reduction and afford improved visualization of bone, implant-tissue interfaces, and periprosthetic soft tissue for the diagnosis of arthroplasty-related complications. In this review article, we discuss strategies for MR imaging around knee arthroplasty implants and illustrate the imaging appearances of common modes of failure, including aseptic loosening, polyethylene wear–induced synovitis and osteolysis, periprosthetic joint infections, fracture, patellar clunk syndrome, recurrent hemarthrosis, arthrofibrosis, component malalignment, extensor mechanism injury, and instability. A systematic approach is provided for evaluation of MR imaging of knee implants. MR imaging with optimized conventional pulse sequences and advanced metal artifact reduction techniques can contribute important information for diagnosis, prognosis, risk stratification, and surgical planning. ©RSNA, 2015 PMID:26295591

  8. Summary of the Preliminary Optical ICHMI Design Study: A Preliminary Engineering Design Study for a Standpipe Viewport

    SciTech Connect

    Anheier, Norman C.; Qiao, Hong; Berglin, Eric J.; Hatchell, Brian K.

    2013-12-26

    This summary report examines an in-vessel optical access concept intended to support standoff optical instrumentation, control and human-machine interface (ICHMI) systems for future advanced small modular reactor (AdvSMR) applications. Optical-based measurement and sensing systems for AdvSMR applications have several key benefits over traditional instrumentation and control systems used to monitor reactor process parameters, such as temperature, flow rate, pressure, and coolant chemistry (Anheier et al. 2013). Direct and continuous visualization of the in-vessel components can be maintained using external cameras. Many optical sensing techniques can be performed remotely using open optical beam path configurations. Not only are in-vessel cables eliminated by these configurations, but also sensitive optical monitoring components (e.g., electronics, lasers, detectors, and cameras) can be placed outside the reactor vessel in the instrument vault, containment building, or other locations where temperatures and radiation levels are much lower. However, the extreme AdvSMR environment present challenges for optical access designs and optical materials. Optical access is not provided in any commercial nuclear power plant or featured in any reactor design, although successful implementation of optical access has been demonstrated in test reactors (Arkani and Gharib 2009). This report outlines the key engineering considerations for an AdvSMR optical access concept. Strict American Society of Mechanical Engineers (ASME) construction codes must be followed for any U.S. nuclear facility component (ASME 2013); however, the scope of this study is to evaluate the preliminary engineering issues for this concept, rather than developing a nuclear-qualified design. In addition, this study does not consider accident design requirements. In-vessel optical access using a standpipe viewport concept serves as a test case to explore the engineering challenges and performance requirements

  9. Joint Line Reconstruction in Navigated Total Knee Arthroplasty Revision

    ClinicalTrials.gov

    2012-05-16

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

  10. Can tranexamic acid change preoperative anemia management during total joint arthroplasty?

    PubMed Central

    Phan, Duy L; Rinehart, Joseph B; Schwarzkopf, Ran

    2015-01-01

    AIM: To investigate the postoperative transfusion and complication rates of anemic and nonanemic total joint arthroplasty patients given tranexamic acid (TXA). METHODS: A cross-sectional prospective study was conducted of primary hip and knee arthroplasty cases performed from 11/2012 to 6/2014. Exclusion criteria included revision arthroplasty, bilateral arthroplasty, acute arthroplasty after fracture, and contraindication to TXA. Patients were screened prior to surgery, with anemia was defined as hemoglobin of less than 12 g/dL for females and of less than 13 g/dL for males. Patients were divided into four different groups, based on the type of arthroplasty (total hip or total knee) and hemoglobin status (anemic or nonanemic). Intraoperatively, all patients received 2 g of intravenous TXA during surgery. Postoperatively, allogeneic blood transfusion (ABT) was directed by both clinical symptoms and relative hemoglobin change. Complications were recorded within the first two weeks after surgery and included thromboembolism, infection, and wound breakdown. The differences in transfusion and complication rates, as well as the relative hemoglobin change, were compared between anemic and nonanemic groups. RESULTS: A total of 232 patients undergoing primary joint arthroplasty were included in the study. For the total hip arthroplasty cohort, 21% (18/84) of patients presented with preoperative anemia. Two patients in the anemic group and two patients in the nonanemic group needed ABTs; this was not significantly different (P = 0.20). One patient in the anemic group presented with a deep venous thromboembolism while no patients in the nonanemic group had an acute complication; this was not significantly different (P = 0.21). For nonanemic patients, the average change in hemoglobin was 2.73 ± 1.17 g/dL. For anemic patients, the average change in hemoglobin was 2.28 ± 0.96 g/dL. Between the two groups, the hemoglobin difference of 0.45 g/dL was not significant (P = 0

  11. Preliminary study of superconducting bulk magnets for Maglev

    NASA Astrophysics Data System (ADS)

    Fujimoto, Hiroyuki; Kamijo, Hiroki

    Recent development shows that melt-processed YBaCuO (Y123) or Rare Earth (RE)123 superconductors have a high Jc at 77 K and high magnetic field, leading to high field application as a superconducting quasi-permanent bulk magnet with the liquid nitrogen refrigeration. One of the promising applications is a superconducting magnet for the magnetically levitated (Maglev) train. We discuss a superconducting bulk magnet for the Maglev train in the aspect of a preliminary design of the bulk magnet and also processing for (L)REBaCuO bulk superconductors and their characteristic superconducting properties.

  12. Decontamination of Johnston Island Coral: a preliminary study

    SciTech Connect

    Kochen, R.L.

    1986-02-17

    A preliminary investigation was completed on the characterization and decontamination of coral samples from Johnston Island. These samples were found to contain individual particles (2 to 0.25 mm) of contaminated coral as well as a piece of contaminated magnetic metal. They ranged in activity from about 70 to 811 nCi Am-241. The decontamination methods investigated were froth flotation, ferrite treatment, attrition scrubbing, ultrasonic treatment and dry sieving. Dry sieving, the more effective technique, separated about 42 wt % of the coral into a decontaminated fraction. This fraction (>4 mm) contained about 0.5% of the total activity. 7 refs., 3 tabs.

  13. Access to regulatory information in Malaysia - a preliminary study.

    PubMed

    Razak, D A

    1996-01-01

    In 1984 Malaysia introduced legislation pertaining to drug regulatory control under The Control of Drugs and Cosmetics Regulations, 1984. A decade after its implementation, the general drug situation in the country has improved considerably and this is reflected in the number of drugs registered using the criteria of quality, safety and efficacy. However, not much attention has been paid to the question of access to regulatory information. This paper reports a preliminary survey on access to regulatory information in Malaysia, and examines the process of drug registration since the implementation of the 1984 regulations.

  14. Preliminary results from a shallow water benthic grazing study

    USGS Publications Warehouse

    Jones, N.L.; Monismith, Stephen G.; Thompson, Janet K.

    2005-01-01

    Despite great improvements in our knowledge on the effects of benthic grazers on seston concentrations in water columns, the effects of different hydrodynamic conditions on grazing rates has not been formulated. This makes it difficult to assess the system-wide effect of the benthic ecosystem on phytoplankton concentrations. Furthermore, it affects our ability to predict the potential success of a benthic species, such as the invasive clams Corbicula fluminea and Potamocorbula amurensis. This paper presents the preliminary results of a control volume approach to elucidate the effect of different hydrodynamic conditions on the grazing rates of Corbicula fluminea.

  15. Crossflow instability control on a swept-wing: Preliminary studies

    NASA Technical Reports Server (NTRS)

    Bridges, David H.

    1994-01-01

    . tunnel is of interest itself, and will be investigated more thoroughly in the future. With a view to these investigations, the boundary layer traverse mechanism in the 20 x 28 in. tunnel was modified to improve its performance, and strain gauges were mounted on the traverse in order to monitor its deflection during a test. Other preliminary work conducted in the 20 x 28 in. tunnel included the use of an infrared camera system. Previous work with this system showed that transition indeed could be detected, but the signal produced by the crossflow vortices was too weak to be detected. It was hoped that spraying the flat plate with naphthalene would augment the heat transfer associated with the crossflow vortices so that they would show up in a IR image; however, experiments showed that this would not work. Another set of tests was conducted in the 20 x 28 in. tunnel to determine the tripping requirements for a set of airfoil-shaped struts that will be used in the 8 feet TPT experiment. Since the Reynolds number associated with these struts is small, a laminar boundary layer would separate early, causing large fluctuations in the flow field. A turbulent boundary layer would remain attached further back, but tripping from laminar to turbulent flow at low Reynolds number is very difficult. However, trip strip configurations were found that should effectively trip the boundary layer at the required conditions. Currently underway is an investigation of the data acquisition requirements for the 8 feet TPT experiment, with the purpose of the finding the minimum amount of data needed to characterize sufficiently the swept-wing boundary layer. This study is being conducted using a numerically generated data set.

  16. [Dislocation-disassembly of bipolar hip arthroplasty--case report].

    PubMed

    Gagała, Jacek; Blacha, Jan

    2005-01-01

    Bipolar hip arthroplasty dislocation is rare. A case of bipolar hip arthroplasty dislocation in patient treated because of femoral neck fracture was described. Patient had neurological problems. The arthroplasty was made with posterolateral approach. Disassembly of bipolar prosthesis occurred during closed reduction. Open reduction with bipolar head exchange was necessary. To avoid this complication reduction should be made in anesthesia with muscles relaxation.

  17. Direct Costs of Aspirin versus Warfarin for Venous Thromboembolism Prophylaxis after Total Knee or Hip Arthroplasty.

    PubMed

    Gutowski, Christina J; Zmistowski, Benjamin M; Lonner, Jess H; Purtill, James J; Parvizi, Javad

    2015-09-01

    Interest in aspirin as an alternative strategy for venous thromboembolism prophylaxis after arthroplasty has grown, as studies have suggested improved clinical efficacy and lower complication rates with aspirin compared to warfarin. The goal of this study was to compare the direct costs of an episode of arthroplasty care, when using aspirin instead of warfarin. The charts of patients who either received aspirin or warfarin after arthroplasty from January 2008 to March 2010 were retrospectively reviewed. Charges were recorded for their index admission, and for subsequent admissions related to either VTE or complications of prophylaxis. Multivariate analysis revealed that aspirin was an independent predictor of decreased cost of index hospitalization, and total episode of care charges, achieved largely through a shorter length of hospitalization. PMID:26073347

  18. Direct Costs of Aspirin versus Warfarin for Venous Thromboembolism Prophylaxis after Total Knee or Hip Arthroplasty.

    PubMed

    Gutowski, Christina J; Zmistowski, Benjamin M; Lonner, Jess H; Purtill, James J; Parvizi, Javad

    2015-09-01

    Interest in aspirin as an alternative strategy for venous thromboembolism prophylaxis after arthroplasty has grown, as studies have suggested improved clinical efficacy and lower complication rates with aspirin compared to warfarin. The goal of this study was to compare the direct costs of an episode of arthroplasty care, when using aspirin instead of warfarin. The charts of patients who either received aspirin or warfarin after arthroplasty from January 2008 to March 2010 were retrospectively reviewed. Charges were recorded for their index admission, and for subsequent admissions related to either VTE or complications of prophylaxis. Multivariate analysis revealed that aspirin was an independent predictor of decreased cost of index hospitalization, and total episode of care charges, achieved largely through a shorter length of hospitalization.

  19. Hip arthroplasty by matching cups.

    PubMed

    Gerard, Y

    1978-01-01

    A total hip surface arthroplasty consisting of matching cups and uncemented prosthetic components is a noteworthy operation. The femoral cup obtains cylindrical support from the femoral head which is reamed in the shape of a cylinder. The acetabular cup is metallic with a polyethylene liner. It is mobile over the bone but its position is constrained by contact with the femoral cup and therefore "self-centering." On the femoral side, the cup must be placed strictly in the axis of the femoral neck. The main consideration in femoral head surface replacement is the vitality of the underlying bone. Necrosis was observed in the earliest clinical trials but there have been no cases of necrosis in the past 3 1/2 years. This is attributed to a more limited surgical approach in which only the anterior part of the gluteus medius is divided and all the posterior elements of the hip are preserved. The acetabulum is sufficiently reamed to receive the cup, which protrudes beyond the external margins of the acetabulum in all positions. Errors have been committed while perfecting the prosthetic material, but the results as determined by a 6 1/2 year follow-up on purely metallic cups are encouraging. Metal-polyethylene cups presently under investigation have almost a 2 year follow-up. The reaction of the acetabulum to an uncemented cup is not yet known. However, the existence of 2 sliding surfaces and the fact that the acetabular cup moves only during the extremes of hip movement, is reason to assume that if the acetabulum is not reamed to expose cancellous bone, the risks of protrusion are minimal or delayed. Total surface arthroplasty by concentric cups has been performed in 335 hips to date. The operation is especially recommended when osteotomy is no longer possible and disabling coxarthrosis is present in relatively young patients. PMID:729253

  20. Can technology improve alignment during knee arthroplasty.

    PubMed

    Thienpont, Emmanuel; Fennema, Peter; Price, Andrew

    2013-09-01

    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.

  1. A Preliminary Case Study for Rectenna Sites in Indonesia

    NASA Astrophysics Data System (ADS)

    Purwanto, Y.; Collins, P.

    2004-12-01

    Electricity power generation using alternative energy sources in Indonesia has become an important policy. Until now, the contribution from alternative energy sources (especially from renewable energy sources) is very small, only about 1% of the total energy supply. It is expected that in the next 10 years this contribution will be raised to 20%. The development of renewable energy sources is primarily performed in remote areas, that are poor in infrastructure facilities. This is considered to be a good policy since there are many such remote areas in Indonesia that need development programs. The existence of Solar Power Satellite system will open a new horizon in alternative energy supply, including Indonesia, because of its higher efficiency compared to conventional terrestrial solar cells, with almost no influence from either climate or solar position. Like other countries in the world, Indonesia, although one of the largest mineral energy producers in the world (i.e. oil, coal, and natural gas), still gives attention to energy diversification programs, including solar energy utilization. SPS, being based on solar energy, could be a good choice. The Indonesian archipelago consists of thousands of islands (more than 13,000) and is the equatorial country with the longest equatorial extent (more than 5000 km). This condition is very good for energy reception from the SPS 2000 pilot plant since the energy transmitting system (spacetenna) will orbit above the equator. Along the equator there could be placed more than four receiving stations (rectenna), especially in remote areas. Thus, it is very important to consider the involvement of Indonesia in SPS energy reception research. This paper describes a preliminary study of the development possibilities in SPS energy reception in Indonesia. To define the rectenna sites and physical development aspect, this study considers some major aspects: environmental, technical, social, and economic aspects. Environmental aspects

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2015-01-01

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

  4. Clinical outcome study and radiological findings of Zweymuller metal on metal total hip arthroplasty. a follow-up of 6 to 15 years.

    PubMed

    Paleochorlidis, Ilias S; Badras, Leonidas S; Skretas, Efstathios F; Georgaklis, Vasilios A; Karachalios, Theofilos S; Malizos, Konstantinos N

    2009-01-01

    We report the clinical and radiological outcome of 99 Zweymuller metal on metal total hip arthroplasties in 84 patients followed up prospectively for a mean period of 9.5 (range, 6-15) years. There were 29 (34.5%) male and 55 (65.5%) female patients with a mean age of 62.85 years (range, 50-70 years) at the time of surgery. All patients had osteoarthritis. One acetabular component and one stem were revised due to aseptic loosening. One femoral stem was revised due to a periprosthetic fracture. HHS score improved from a preoperative mean of 62.56 points (SD 8.87) to a final postoperative follow-up mean of 93.48 (SD 7.7). Cumulative success rate for both implants at 13 years, with aseptic loosening as the end point, was 97.05%, while for both implants at 13 years, with revision for any reason as the end point, it was 91.17%. Satisfactory results were observed with the use of this prosthesis. PMID:20041375

  5. Ceramic on Ceramic or Ceramic-on-polyethylene for Total Hip Arthroplasty: A Systemic Review and Meta-analysis of Prospective Randomized Studies

    PubMed Central

    Dong, Yu-Lei; Li, Tao; Xiao, Ke; Bian, Yan-Yan; Weng, Xi-Sheng

    2015-01-01

    Background: Wear debris of polyethylene has become a restraining factor of the durability for total hip arthroplasty (THA). Ceramic on ceramic (COC) has better wear resistance while the squeaking sound and prosthesis fracture are of concern. It is still a controversy that bearing couples are better for THA. Methods: We performed a systematic review of all English articles identified from PubMed (1966-), Embase (1980-) and the Cochrane Library. Clinical outcomes, complications, revision rates, and radiographic outcomes of COC-THA and ceramic on polyethylene (COP)-THA were compared and evaluated. Results: Eight prospective randomized trials enrolling a total of 1508 patients and 1702 THA surgeries were identified. Our results demonstrated the prosthesis fracture and the squeaking sound is significantly higher in COC group and higher wear rate of the COP. Hip function, loosening rate, dislocation rate, revision rate, and the osteolysis rate were comparable between two groups. According to Grading of Recommendations Assessment, Development and Evaluation system assessment, the strength of evidence was high for prosthesis fracture, dislocation, osteolysis, and moderate for radiolucent line or loosening, hip noise, and revision. Conclusions: Up to now, there is insufficient evidence to identify any clinical advantage of COC compared with COP. Longer follow-up of larger randomized trial is needed to clarify the outcomes. PMID:25947407

  6. A longitudinal study of MARS MRI scanning of soft-tissue lesions around metal-on-metal total hip arthroplasties and disease progression.

    PubMed

    Briant-Evans, T W; Lyle, N; Barbur, S; Hauptfleisch, J; Amess, R; Pearce, A R; Conn, K S; Stranks, G J; Britton, J M

    2015-10-01

    We investigated the changes seen on serial metal artefact reduction magnetic resonance imaging scans (MARS-MRI) of metal-on-metal total hip arthroplasties (MoM THAs). In total 155 THAs, in 35 male and 100 female patients (mean age 70.4 years, 42 to 91), underwent at least two MRI scans at a mean interval of 14.6 months (2.6 to 57.1), at a mean of 48.2 months (3.5 to 93.3) after primary hip surgery. Scans were graded using a modification of the Oxford classification. Progression of disease was defined as an increase in grade or a minimum 10% increase in fluid lesion volume at second scan. A total of 16 hips (30%) initially classified as 'normal' developed an abnormality on the second scan. Of those with 'isolated trochanteric fluid' 9 (47%) underwent disease progression, as did 7 (58%) of 'effusions'. A total of 54 (77%) of hips initially classified as showing adverse reactions to metal debris (ARMD) progressed, with higher rates of progression in higher grades. Disease progression was associated with high blood cobalt levels or an irregular pseudocapsule lining at the initial scan. There was no association with changes in functional scores. Adverse reactions to metal debris in MoM THAs may not be as benign as previous reports have suggested. Close radiological follow-up is recommended, particularly in high-risk groups. PMID:26430006

  7. A longitudinal study of MARS MRI scanning of soft-tissue lesions around metal-on-metal total hip arthroplasties and disease progression.

    PubMed

    Briant-Evans, T W; Lyle, N; Barbur, S; Hauptfleisch, J; Amess, R; Pearce, A R; Conn, K S; Stranks, G J; Britton, J M

    2015-10-01

    We investigated the changes seen on serial metal artefact reduction magnetic resonance imaging scans (MARS-MRI) of metal-on-metal total hip arthroplasties (MoM THAs). In total 155 THAs, in 35 male and 100 female patients (mean age 70.4 years, 42 to 91), underwent at least two MRI scans at a mean interval of 14.6 months (2.6 to 57.1), at a mean of 48.2 months (3.5 to 93.3) after primary hip surgery. Scans were graded using a modification of the Oxford classification. Progression of disease was defined as an increase in grade or a minimum 10% increase in fluid lesion volume at second scan. A total of 16 hips (30%) initially classified as 'normal' developed an abnormality on the second scan. Of those with 'isolated trochanteric fluid' 9 (47%) underwent disease progression, as did 7 (58%) of 'effusions'. A total of 54 (77%) of hips initially classified as showing adverse reactions to metal debris (ARMD) progressed, with higher rates of progression in higher grades. Disease progression was associated with high blood cobalt levels or an irregular pseudocapsule lining at the initial scan. There was no association with changes in functional scores. Adverse reactions to metal debris in MoM THAs may not be as benign as previous reports have suggested. Close radiological follow-up is recommended, particularly in high-risk groups.

  8. A preliminary study of the modified Ericsson for space power

    NASA Technical Reports Server (NTRS)

    Berner, J.; Louis, J. F.; Juhasz, A.

    1985-01-01

    Simple modifications of the Ericsson cycle are analyzed for their application as high power, compact and reliable space power systems. They use the same components as the technologically advanced and reliable Brayton system. These modifications approximate the Ericsson cycle's isothermal expansion by several stages of expansion with reheat and the isothermal compression by several compression stages with intercooling. Preliminary cycle analysis including non-ideal components indicates potential advantages in both power per unit area and efficiency over the Brayton system. Evaluation of the system mass indicates a significant mass and radiator area advantage of a Modified Ericsson cycle using one reheat and one expansion stage when a high temperature titanium radiator is used. Whereas the configuration using one reheat and one intercooling with two stages of compression and expansion provided the lowest mass per unit power using a lower temperature aluminum radiator.

  9. Characterization and subsequent utilization of microbially solubilized coal: Preliminary studies

    SciTech Connect

    Davison, B.H.; Nicklaus, D.M.; Woodward, C.A.; Lewis, S.N.; Faison, B.D.

    1989-01-01

    The solubilization of low-ranked coals by fungi, such as Paecilomyces and Candida, in defined submerged culture systems has been demonstrated. Current efforts focus on the characterization of the aqueous solubilized coal products and the development of technologies for their subsequent utilization. Solubilized coal products have been fractionated, and preliminary characterizations performed. Differences in product composition have been detected with respect to the organism used in culture duration. Prospects for the conversion of the aerobically-solubilized coal into less-oxidized products have been developed which can remain active and viable in the presence of the aqueous coal product or vanillin, a coal model compound. The results suggest that a methanogenic consortium was able to produce methane and carbon dioxide from the product of coal biosolubilization by Paecilomyces as a sole carbon source. Work continues on the development of cultures able to convert the aqueous coal product and its various fractions into methane or fuel alcohols. 17 refs., 8 figs.

  10. Preliminary study on the RF tuning of CSNS DTL

    NASA Astrophysics Data System (ADS)

    Yin, Xue-Jun; Li, A.-Hong; Xiao, Yong-Chuang; Chen, Qiang; Liu, Hua-Chang; Gong, Ke-Yun; Fu, Shi-Nian

    2014-02-01

    In the R&D of the CSNS Drift Tube Linac (DTL), the first unit tank with 28 drift tubes has been developed. The axial accelerating field is ramped from 2.2 MV/m to 3.1 MV/m in this tank. The required field flatness is less than ±2% with the standard deviation of 1% for the beam dynamics; the field stability should be less than 1% for machine stable operation. After successful alignment, RF tuning was carried out focusing on the field profile measurement. Four slug tuners and eleven post couplers were applied in this procedure. The ramped field and required stability had been achieved by fine adjustment of the slug tuners and post couplers. In this paper, the preliminary tuning results are presented and discussed.

  11. Preliminary study of niobium alloy contamination by transport through helium

    NASA Technical Reports Server (NTRS)

    Scheuermann, Coulson M.; Moore, Thomas J.; Wheeler, Donald R.

    1987-01-01

    Preliminary tests were conducted to determine if interstitial element transport through a circulating helium working fluid was a potential problem in Brayton and Stirling space power systems. Test specimens exposed to a thermal gradient for up to 3000-hr included Nb-1%Zr, a Sm-Co alloy (referred to as SmCo in this paper), Hiperco 50 steel, and alumina to simulate various engine components of the Brayton and Stirling systems. Results indicate that helium transport of interstitial contaminants can be minimized over a 7-yr life with a monometallic Nb-1%Zr design. Exposure with other materials indicated a potential for interstitial contaminant transport. Determination of contamination kinetics and the effects on structural integrity will require additional testing.

  12. A prospective evaluation of 2 different pain management protocols for total hip arthroplasty.

    PubMed

    Post, Zachary D; Restrepo, Camilo; Kahl, Lauren K; van de Leur, Tim; Purtill, James J; Hozack, William J

    2010-04-01

    Pain management after total hip arthroplasty has improved dramatically in the past decade. However, most protocols use opioid medications for pain control. In the current study, 100 patients were prospectively selected to receive a traditional narcotic-based patient-controlled analgesia protocol or a nonnarcotic oral protocol for pain management after primary total hip arthroplasty. Therapy programs were similar for both groups. Postoperatively, patients were followed daily for opioid use, medication adverse effects, pain control, and overall satisfaction. The nonnarcotic oral group showed lower mean pain scores during the first 24 hours after surgery. The satisfaction rate was high in both groups. Both protocols provided adequate pain control after total hip arthroplasty; the nonnarcotic pain management protocol resulted in significantly decreased opioid consumption and fewer adverse effects.

  13. Racial/Ethnic Disparity in Rates and Outcomes of Total Joint Arthroplasty.

    PubMed

    Shahid, Hania; Singh, Jasvinder A

    2016-04-01

    Racial/ethnic disparity in total joint arthroplasty (TJA) has grown over the last two decades as studies have documented the widening gap between Blacks and Whites in TJA utilization rates despite the known benefits of TJA. Factors contributing to this disparity have been explored and include demographics, socioeconomic status, patient knowledge, patient preference, willingness to undergo TJA, patient expectation of post-arthroplasty outcome, religion/spirituality, and physician-patient interaction. Improvement in patient knowledge by effective physician-patient communication and other methods can possibly influence patient's perception of the procedure. Such interventions can provide patient-relevant data on benefits/risks and dispel myths related to benefits/risks of arthroplasty and possibly reduce this disparity. This review will summarize the literature on racial/ethnic disparity on TJA utilization and outcomes and the factors underlying this disparity. PMID:26984804

  14. Comparison of arthroplasty trial publications after registration in ClinicalTrials.gov.

    PubMed

    Smith, Holly N; Bhandari, Mohit; Mahomed, Nizar N; Jan, Meryam; Gandhi, Rajiv

    2012-08-01

    In 2005, the International Committee of Medical Journal Editors established a mandatory trial registration before study enrollment for publication in member journals. Our primary objective was to evaluate the publication rates of arthroplasty trials registered with ClinicalTrials.gov (CTG). We further aimed to examine the consistency of registration summaries with that of final publications. We searched CTG for all trials related to joint arthroplasty and conducted a thorough search for publications resulting from registered closed trials. Of 101 closed and completed trials, we found 23 publications, for an overall publication rate of 22.8%. Registration of arthroplasty trials in CTG does not consistently result in publication or disclosure of results. In addition, changes are frequently made to the final presentation of the data that are not reflected in the trial registry.

  15. Medicare Reimbursement Attributable to Periprosthetic Joint Infection Following Primary Hip and Knee Arthroplasty.

    PubMed

    Yi, Sarah H; Baggs, James; Culler, Steven D; Berríos-Torres, Sandra I; Jernigan, John A

    2015-06-01

    This study estimated Medicare reimbursement attributable to periprosthetic joint infection (PJI) across the continuum of covered services four years following hip or knee arthroplasty. Using 2001-2008 Medicare claims data, total and annual attributable reimbursements were assessed using generalized linear regression, adjusting for potential confounders. Within one year following arthroplasty, 109 (1.04%) of 10,418 beneficiaries were diagnosed with PJI. Cumulative Medicare reimbursement in the PJI arm was 2.2-fold (1.9-2.6, P<.0001) or $53,470 ($39,575-$68,221) higher than that of the non-PJI arm. The largest difference in reimbursement occurred the first year (3.2-fold); differences persisted the second (2.3-fold) and third (1.9-fold) follow up years. PJI following hip or knee arthroplasty appears costly to Medicare, with cost traversing several years and health care service areas.

  16. Racial/Ethnic Disparity in Rates and Outcomes of Total Joint Arthroplasty.

    PubMed

    Shahid, Hania; Singh, Jasvinder A

    2016-04-01

    Racial/ethnic disparity in total joint arthroplasty (TJA) has grown over the last two decades as studies have documented the widening gap between Blacks and Whites in TJA utilization rates despite the known benefits of TJA. Factors contributing to this disparity have been explored and include demographics, socioeconomic status, patient knowledge, patient preference, willingness to undergo TJA, patient expectation of post-arthroplasty outcome, religion/spirituality, and physician-patient interaction. Improvement in patient knowledge by effective physician-patient communication and other methods can possibly influence patient's perception of the procedure. Such interventions can provide patient-relevant data on benefits/risks and dispel myths related to benefits/risks of arthroplasty and possibly reduce this disparity. This review will summarize the literature on racial/ethnic disparity on TJA utilization and outcomes and the factors underlying this disparity.

  17. Revision total knee arthroplasty: infection should be ruled out in all cases.

    PubMed

    Rasouli, Mohammad R; Harandi, Armin Aalami; Adeli, Bahar; Purtill, James J; Parvizi, Javad

    2012-06-01

    We hypothesized that some aseptic revision total knee arthroplasty failures are indeed caused by occult infection. This prospective study recruited 65 patients undergoing revision total knee arthroplasty. The mean follow-up period was 19 months. Collected synovial fluid was analyzed by Ibis T5000 biosensor (Abbott Molecular Inc, Ill; a multiplex polymerase chain reaction technology). Cases were considered as infected or aseptic based on the surgeon's judgment and Ibis findings. Based on Ibis biosensor, 17 aseptic cases were indeed infected that had been missed. Of these 17 cases, 2 developed infection after the index revision. A considerable number of so-called aseptic failures seem to be occult infections that were not adequately investigated and/or miscategorized as aseptic failure. We recommend that all patients undergoing revision arthroplasty be investigated for periprosthetic joint infection. PMID:22386605

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

    PubMed Central

    2014-01-01

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

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

    PubMed Central

    2013-01-01

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

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

    PubMed

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

    2013-11-01

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

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

    PubMed

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

    2013-11-01

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

  2. Durability of highly cross-linked polyethylene in total hip and total knee arthroplasty.

    PubMed

    Dion, Neil T; Bragdon, Charles; Muratoglu, Orhun; Freiberg, Andrew A

    2015-07-01

    This article reviews the history of the development of highly cross-linked polyethylene and provides an in-depth review of the clinical results regarding the durability of highly cross-linked polyethylene (HXLPE) used in total hip arthroplasty (THA) and total knee arthroplasty (TKA). The use of polyethylene as a bearing surface has contributed to the success of THA and TKA; however, polyethylene wear and osteolysis can lead to failure. Ongoing clinical and retrieval studies are required to analyze outcomes at longer-term follow-up.

  3. Durability of highly cross-linked polyethylene in total hip and total knee arthroplasty.

    PubMed

    Dion, Neil T; Bragdon, Charles; Muratoglu, Orhun; Freiberg, Andrew A

    2015-07-01

    This article reviews the history of the development of highly cross-linked polyethylene and provides an in-depth review of the clinical results regarding the durability of highly cross-linked polyethylene (HXLPE) used in total hip arthroplasty (THA) and total knee arthroplasty (TKA). The use of polyethylene as a bearing surface has contributed to the success of THA and TKA; however, polyethylene wear and osteolysis can lead to failure. Ongoing clinical and retrieval studies are required to analyze outcomes at longer-term follow-up. PMID:26043046

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

    PubMed

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

    2014-06-01

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

  5. Long head of the biceps pathology as a cause of anterior shoulder pain after shoulder arthroplasty.

    PubMed

    Tuckman, David V; Dines, David M

    2006-01-01

    The use of shoulder arthroplasty has been increasing over the last decade, with nearly 20,000 shoulder arthroplasties being performed each year. Although many patients have excellent results, there exists a subset of patients in whom anterior catching shoulder pain develops after arthroplasty. The purpose of this study was to examine this group of patients and explore treatment options and outcomes for this condition. We undertook a review of 8 shoulders in 7 patients who were treated for anterior shoulder pain radiating into the biceps muscle after shoulder arthroplasty. Three patients had a hemiarthroplasty for fracture, and five had a total shoulder arthroplasty. All patients had anterior shoulder pain with physical examination findings consistent with biceps tendon pathology. Definitive diagnosis and treatment consisted of either arthroscopy, in 7 of 8 shoulders, or an open procedure, in 1 of 8 shoulders. The range of motion improved in all shoulders. The hemiarthroplasty group showed an increase in flexion of 36 degrees (range, 68 degrees -104 degrees ), external rotation of 23 degrees (range, 11 degrees -34 degrees ), and internal rotation to L4. The total shoulder group demonstrated an increase in flexion of 50 degrees (range, 66 degrees -166 degrees ), external rotation of 27 degrees (range, 22 degrees -39 degrees ), and internal rotation to L3. The Hospital for Special Surgery score improved in all shoulders, with all patients being satisfied with their final outcome. Pain scores improved from a mean of 6.9 (range, 4-9) preoperatively to 1.4 (range, 0.5-2) postoperatively on a scale of 1 to 10, with 10 indicating the most pain. The role of the biceps tendon in the pathology of anterior shoulder pain after shoulder arthroplasty appears to be consistent with fibrosis and inflammation. Initial results, achieved with arthroscopic debridement or tenodesis, were encouraging.

  6. Nerve Injury in Patients Following Hip and Knee Arthroplasties and Knee Arthroscopy

    PubMed Central

    Yacub, Jennifer N.; Rice, J. Bradford; Dillingham, Timothy R.

    2016-01-01

    Objective To examine the reporting of lower limb neuropathy within 90 days of surgery for patients undergoing hip arthroplasty, knee arthroplasty or knee arthroscopy. Design This was a retrospective study utilizing data from the 1998 MarketScan Commercial Claims and Encounter Database (The MEDSTAT Group) to identify lower limb neuropathy following these surgeries. The sample was selected within the first nine months of 1998 using ICD-9 and CPT codes for hip and knee surgical procedures. Lower limb nerve injuries as determined by ICD-9 codes within 90 days post surgery were the main outcome measures. The influence of diabetes on the rates of nerve injuries following surgery was also examined. Results 14,979 patients underwent these surgical procedures, 10 of whom were reported to have sustained a nerve injury post surgery (0.07%). A majority (53.1%) of the sample was male and the largest age groups consisted of those aged 45–54 years (27.0%) and those aged 55–64 years (27.7%). Nerve injury occurred at a rate of 0.03% after hip arthroplasty, 0.01% following knee arthroplasty and 0.02% within three months of arthroscopic knee surgery. Overall, nerve injuries were two times more prevalent in the diabetic vs. non-diabetic population (0.11% vs. 0.06%); however, this difference did not meet conventional levels of statistical significance. Specific to knee arthroplasty, there were ten-fold differences in nerve injury rates between diabetics and non-diabetics, 0.11% vs. 0.01% respectively (p ≤ 0.01) – although the overall risks were small. Conclusion Nerve injuries following hip and knee arthroplasty, and knee arthroscopy were rare in a large population of patients younger than 65 years. Although the overall rates were low, there was an increased occurrence of nerve injuries in the diabetic population. This information is useful when counseling patients and benchmarking surgical complication rates. PMID:19620828

  7. No statistically significant kinematic difference found between a cruciate-retaining and posterior-stabilised Triathlon knee arthroplasty: a laboratory study involving eight cadavers examining soft-tissue laxity.

    PubMed

    Hunt, N C; Ghosh, K M; Blain, A P; Rushton, S P; Longstaff, L M; Deehan, D J

    2015-05-01

    The aim of this study was to compare the maximum laxity conferred by the cruciate-retaining (CR) and posterior-stabilised (PS) Triathlon single-radius total knee arthroplasty (TKA) for anterior drawer, varus-valgus opening and rotation in eight cadaver knees through a defined arc of flexion (0º to 110º). The null hypothesis was that the limits of laxity of CR- and PS-TKAs are not significantly different. The investigation was undertaken in eight loaded cadaver knees undergoing subjective stress testing using a measurement rig. Firstly the native knee was tested prior to preparation for CR-TKA and subsequently for PS-TKA implantation. Surgical navigation was used to track maximal displacements/rotations at 0º, 30º, 60º, 90º and 110° of flexion. Mixed-effects modelling was used to define the behaviour of the TKAs. The laxity measured for the CR- and PS-TKAs revealed no statistically significant differences over the studied flexion arc for the two versions of TKA. Compared with the native knee both TKAs exhibited slightly increased anterior drawer and decreased varus-valgus and internal-external roational laxities. We believe further study is required to define the clinical states for which the additional constraint offered by a PS-TKA implant may be beneficial.

  8. The femoral sulcus in total knee arthroplasty.

    PubMed

    Lingaraj, Krishna; Bartlett, John

    2009-05-01

    The position of the femoral sulcus relative to the midline of the distal femoral resection in total knee arthroplasty (TKA) was studied to determine if centralized placement of the femoral component on the distal femur was justified in terms of aligning the prosthetic sulcus with the native femoral sulcus. The location of the femoral sulcus was studied in 112 consecutive patients undergoing TKA. The mean sulcus position was 0.7 mm lateral to the midline of the distal femoral resection (SD 1.4, 95% CI, 0.5-1.0 mm). However, the variation in sulcus positions ranged from 4 mm medial to 4 mm lateral to the midline. The mean sulcus position in valgus knees was 1.0 mm lateral to the midline (SD 1.8), and that in varus knees was 0.7 mm lateral to the midline (SD 1.2) (P = 0.501). It appears prudent to centre the femoral component on the native sulcus rather than the midline of the distal femoral resection, so as to ensure accurate alignment of the prosthetic sulcus with the native sulcus and to encourage normal patella tracking.

  9. Effects of Home-Based Interval Walking Training on Thigh Muscle Strength and Aerobic Capacity in Female Total Hip Arthroplasty Patients: A Randomized, Controlled Pilot Study

    PubMed Central

    Morishima, Yutaka; Mizushima, Takashi; Yamauchi, Katsuya; Morikawa, Mayuko; Masuki, Shizue; Nose, Hiroshi

    2014-01-01

    Due to the reduced physical activity of patients who have undergone total hip arthroplasty (THA), there are no home-based exercise training regimens for preventing muscle atrophy and aerobic capacity impairment in these patients. We examined whether interval walking training (IWT) could prevented these issues. Twenty-eight female patients (∼60 years of age) who had undergone THA more than 2 months prior were randomly divided into IWT (n = 14) and control (CNT, n = 14) groups. The IWT subjects trained at a target of 60 min of fast walking at >70% peak aerobic capacity for walking (O2peak) per wk for 12 wk, while those in the CNT maintained their previous sedentary life during the same period. We measured the energy expenditure of the daily physical activity, except during sleeping and bathing, every minute and every day during the intervention. We also measured the isometric knee extension (FEXT) and flexion (FFLX) forces, O2peak, and anaerobic threshold during the graded cycling exercise (O2AT) before and after the intervention. All subjects, except for one in IWT, completed the protocol. FFLX increased by 23% on the operated side (P = 0.003) and 14% on the non-operated side of IWT (P = 0.006), while it only increased on the operated side of CNT (P = 0.03). The O2peak and O2AT in IWT increased by 8% (P = 0.08) and 13% (P = 0.002), respectively, and these changes were significantly higher in the IWT than in CNT group (both, P<0.05). In conclusion, IWT might be an effective home-based training regimen for preventing the muscle atrophy from reduced daily physical activity in THA patients. Trial Registration UMIN-CTR UMIN000013172 PMID:25268505

  10. Preliminary Studies of a Pulsed Detonation Rocket Engine

    NASA Technical Reports Server (NTRS)

    Cambier, Jean-Luc; Adelman, H. G.; Menees, G. P.; Edwards, Thomas A. (Technical Monitor)

    1995-01-01

    In the new era of space exploration, there is a strong need for more efficient, cheaper and more reliable propulsion devices. With dramatic increase in specific impulse, the overall mass of fuel to be lifted into orbit is decreased, and this leads, in turn, to much lower mass requirements at lift-off, higher payload ratios and lower launch costs. The Pulsed Detonation engine (PDE) has received much attention lately due to its unique combination of simplicity, light-weight and efficiency. Current investigations focus principally on its use as a low speed, airbreathing engine, although other applications have also been proposed. Its use as a rocket propulsion device was first proposed in 1988 by the present authors. The superior efficiency of the Pulsed Detonation Rocket Engine (PDRE) is due to the near constant volume combustion process of a detonation wave. Our preliminary estimates suggest that the PDRE is theoretically capable of achieving specific impulses as high as 720 sec, a dramatic improvement over the current 480 sec of conventional rocket engines, making it competitive with nuclear thermal rockets. In addition to this remarkable efficiency, the PDRE may eliminate the need for high pressure cryogenic turbopumps, a principal source of failures. The heat transfer rates are also much lower, eliminating the need for nozzle cooling. Overall, the engine is more reliable and has a much lower weight. This paper will describe in detail the operation of the PDRE and calculate its performance, through numerical simulations. Engineering issues will be addressed and discussed, and the impact on mission profiles will also be presented. Finally, the performance of the PDRE using in-situ resources, such as CO and O2 from the martian atmosphere, will also be computed.

  11. A Preliminary Study of Seismicity at Ceboruco, Volcano, Nayarit, Mexico

    NASA Astrophysics Data System (ADS)

    Sanchez, J. J.; Nunez-Cornu, F. J.; Suarez-Plascencia, C.; Trejo-Gomez, E.

    2007-12-01

    Ceboruco Volcano is located northwestern of Tepic-Zacoalco graben (Jalisco, Mexico). Its volcanic activity can be divided in four eruptive cycles differentiated by their volcano explosivity index (VEI) and chemical variations as well. As a result of andesitic effusive activity, during the first cycle the "paleo-Ceboruco" edifice was constructed. The end of this cycle is defined by a plinian eruption (VEI is estimated between 3 and 4) which occurred some 1020 years ago and formed the external caldera. During the second cycle an andesitic dome extruded in the interior of the caldera. The dome, called Dos Equis, collapsed and formed the internal caldera. The third cycle is represented by andesitic lava flows which partially cover the northern and south-southwestern part of the edifice. The last cycle is represented by historic andesitic lava flows located in the southwestern flank of the volcano. In February 2003 as part of an agreement with Nayarit Civil Defense a seismic station was installed in the SW flank of the volcano. The station is equipped with a Marslite (lennartz) digitizer with a 3DLe 1Hz. seismic sensor. Detection system is based on a STA/LTA recording algorithm. More than 2000 small earthquakes have been attributed to various local sources, and some of this earthquakes are possibly located beneath Ceboruco volcano. A preliminary classification separates high frequency and low frequency seismic events. The sources of high frequency earthquakes appear to be distributed as evidenced from waveforms variety and changing S-P arrivals separations. The low frequency seismic events also show varying signatures and some of them exhibit extended coda, including some monochromatic character.

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

    PubMed Central

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

    2014-01-01

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

  13. Emerging technologies in arthroplasty: additive manufacturing.

    PubMed

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

    2014-06-01

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

  14. Muscular strength after total hip arthroplasty

    PubMed Central

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

    2016-01-01

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

  15. Extensor tendon ruptures after total knee arthroplasty.

    PubMed

    Bonnin, M; Lustig, S; Huten, D

    2016-02-01

    Extensor tendon rupture is a rare but serious complication after total knee arthroplasty (TKA) that impairs active knee extension, thereby severely affecting knee function. Surgery is usually required. Surgical options range from simple suturing to allograft reconstruction of the entire extensor mechanism and include intermediate methods such as reconstruction using neighbouring tendons or muscles, synthetic ligament implantation, and partial allograft repair. Simple suturing carries a high failure rate and should therefore be routinely combined with tissue augmentation using a neighbouring tendon or a synthetic ligament. After allograft reconstruction, outcomes are variable and long-term complications common. Salvage procedures for managing the most severe cases after allograft failure involve reconstruction using gastrocnemius or vastus flaps. Regardless of the technique used, suturing must be performed under tension, with the knee fully extended, and rehabilitation must be conducted with great caution. Weaknesses of available case-series studies include small sample sizes, heterogeneity, and inadequate follow-up duration. All treatment options are associated with substantial failure rates. The patient should be informed of this fact and plans made for a salvage option. Here, the main techniques and their outcomes are discussed, and a therapeutic strategy is suggested.

  16. Emerging technologies in arthroplasty: additive manufacturing.

    PubMed

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

    2014-06-01

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

  17. [Clinical evaluation tools of total hip arthroplasties].

    PubMed

    Hamadouche, M

    2006-10-01

    Total hip arthroplasty is one of the most efficient hip surgery procedures enabling improved function in the vast majority of operated patients. The major long-term complication is aseptic loosening due to an inflammatory response to particle wear debris coming from the bearings. Polyethylene is the key culprit. Currently two solutions are proposed: eliminating polyethylene from the prosthetic articulation or reducing material wear. This leads to the need for reliable tools for evaluating short-term results, predictive of long-term outcome. When the innovation concerns reduction of polyethylene wear, short-term wear should be measured with software methods or radiostereometry. If the innovation concerns improvement of polyethyleneless implants, then short-term migration should be measured with EBRA or radiostereometry. In addition, the long-term retrospective evaluation of large series of patients remains of major interest provided that it is performed with survival analysis. These different methods are detailed in this study, indicating the pros and cons for each solution. PMID:17088755

  18. Clinical Biomechanics of Wear in Total Hip Arthroplasty

    PubMed Central

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

    2003-01-01

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

  19. Knee joint arthroplasty after tibial osteotomy

    PubMed Central

    Fosco, Matteo; Cenni, Elisabetta; Tigani, Domenico

    2009-01-01

    A total of 29 consecutive knee joint arthroplasties in 24 patients who underwent previous high tibial osteotomy (HTO) for medial unicompartment osteoarthritis of the knee and followed up for a mean of 97 months were compared with a control group of 28 patients with 29 primary total knee arthroplasty (TKA) without previous HTO. Results for the osteotomy group were satisfactory in 96.5% of cases. In one patient loosening of the implant occurred after 37 months, which required prosthesis revision. Three patients underwent a further operation of secondary patella resurfacing for patella pain. The group without osteotomy reported a similar percentage of satisfactory results. PMID:19882155

  20. Clinical and radiological outcomes of the Ivory arthroplasty for trapeziometacarpal joint osteoarthritis with a minimum of 5 years of follow-up: a prospective single-centre cohort study.

    PubMed

    Goubau, J F; Goorens, C K; Van Hoonacker, P; Berghs, B; Kerckhove, D; Scheerlinck, T

    2013-10-01

    We present the results of a 5 year prospective follow-up study on the functional outcome after total replacement of the trapeziometacarpal joint with the Ivory prosthesis (Memometal, Stryker Corporate, Kalamazoo, Michigan, USA) in 22 patients. The female to male ratio was 21:1 and the mean age was 66 (range 54-78) years. The mean follow-up period was 67 (range 60-77) months after operation. Patient satisfaction was high. The mobility of the operated thumb was restored to a range of motion comparable to the contralateral thumb. Key pinch and grip strength improved by 13% and 31%, respectively. Overall function, according to Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, improved by 59%. Pain decreased by 85% according to the numerical rating scale. Radiological evaluation revealed no loosening of the implant after 5 years except in one patient who required revision due to polythene wear with secondary joint instability. Another patient had asymptomatic polythene wear that required no revision but remains in follow-up. The 5 year overall survival of the prosthesis was 95%. These medium-term results suggest that the Ivory arthroplasty is a reliable option for treating advanced trapeziometacarpal arthritis, because it appears to give a very good functional outcome and has the potential for long-term survival rates.

  1. Battery energy storage: A preliminary assessment of national benefits (the Gateway Benefits Study)

    SciTech Connect

    Akhil, A.; Zaininger, H.; Hurwitch, J.; Badin, J.

    1993-12-01

    Preliminary estimates of national benefits from electric utility applications of battery energy storage through the year 2010 are presented along with a discussion of the particular applications studied. The estimates in this report were based on planning information reported to DOE by electric utilities across the United States. Future studies are planned to refine these estimates as more application-specific information becomes available.

  2. Preliminary Design Study of a National Program for Training Skilled Aviation Personnel.

    ERIC Educational Resources Information Center

    Arizona State Univ., Tempe.

    This study supplementing a 1967 study of Arizona State University, recommends preliminary plans for the design of a national training center capable of accommodating 2,200 fliers and aviation technicians and the steps that should be taken to complete the facility by September 1972. Specific recommendations are: (1) negotiations between the…

  3. Preliminary Study: Special Education Doctoral Students' Perceptions of Self-Determination

    ERIC Educational Resources Information Center

    Kim, Kyeong-Hwa; Morningstar, Mary E.; Jung, Sungmin

    2014-01-01

    This preliminary study investigated 118 special education doctoral students' knowledge of and attitudes toward self-determination. In addition, this study examined the relationship between self-determination coursework and special education doctoral students' perceptions of how well they were prepared for implementing self-determination…

  4. Identification of Emerging Self-Injurious Behavior in Young Children: A Preliminary Study

    ERIC Educational Resources Information Center

    Kurtz, Patricia F.; Chin, Michelle D.; Huete, John M.; Cataldo, Michael F.

    2012-01-01

    Self-injurious behavior (SIB) is a chronic disorder that often begins in early childhood; however, few studies have examined the onset of SIB in young children. This preliminary study reports on the identification, assessment, and observation of SIB in 32 children who had begun to engage in SIB within the previous 6 months. Participants were under…

  5. A Preliminary Study of Guided Math in Title I Elementary Schools

    ERIC Educational Resources Information Center

    Fielder, Katherine Roberts

    2013-01-01

    This study sought to provide a preliminary examination of the relationship between the implementation of Guided Math and student achievement in Title I schools as measured by the percentage of students who met or exceeded the standard for the Georgia Mathematics CRCT. The study examined data from thirty Title I elementary schools in one suburban…

  6. PAIN FOLLOWING TOTAL KNEE ARTHROPLASTY – A SYSTEMATIC APPROACH

    PubMed Central

    Alves, Wilson Mello; Migon, Eduardo Zaniol; Zabeu, Jose Luis Amim

    2015-01-01

    Total knee arthroplasty (TKA) is known to be a successful procedure. The aging of the population and the growing demand for quality of life have greatly increased the indications for the procedure. Nonetheless, TKA presents some complications that still lack definitive resolution. Pain after TKA is caused by a myriad of reasons that need to be systematically studied in order to reach the correct diagnosis and treatment. History, physical examination, laboratory tests and imaging examinations must all be included in the workup and repeated until a plausible reason has been identified, since if pain is the only indication for TKA revision, the results may be catastrophic. PMID:27022583

  7. Medialized Versus Lateralized Center of Rotation in Reverse Shoulder Arthroplasty.

    PubMed

    Streit, Jonathan J; Shishani, Yousef; Gobezie, Reuben

    2015-12-01

    Reverse shoulder arthroplasty may be performed using components that medialize or lateralize the center of rotation. The purpose of this prospective study was to directly compare 2 reverse shoulder arthroplasty designs. Two treatment groups and 1 control group were identified. Group I comprised 9 patients using a medialized Grammont-style (GRM) prosthesis with a neck-shaft angle of 155°. Group II comprised 9 patients using a lateralized (LAT) prosthesis with a neck-shaft angle of 135°. Pre- and postoperative assessment of range of motion, American Shoulder and Elbow Surgeons score, and visual analog scale pain score were performed. Radiographic measurements of lateral humeral offset and acromiohumeral distance were compared. The GRM prosthesis achieved greater forward flexion (143.9° vs 115.6°; P=.05), whereas the LAT achieved greater external rotation (35.0° vs 28.3°; P=.07). The lateral humeral offset was greater for the LAT prosthesis compared with the GRM prosthesis, but this distance was not significantly different from that found in the control group. The acromiohumeral distance was significantly greater in the GRM prosthesis group compared with both the LAT and the control groups. The results of this study confirm that different reverse shoulder arthroplasty designs produce radiographically different anatomy. Whereas the GRM prosthesis significantly alters the anatomy of the shoulder, the LAT design can preserve some anatomic relationships found in the normal shoulder. The clinical outcomes indicate that this may have an effect on range of motion, with traditional designs achieving greater forward flexion and lateralized designs achieving greater external rotation.

  8. Medialized Versus Lateralized Center of Rotation in Reverse Shoulder Arthroplasty.

    PubMed

    Streit, Jonathan J; Shishani, Yousef; Gobezie, Reuben

    2015-12-01

    Reverse shoulder arthroplasty may be performed using components that medialize or lateralize the center of rotation. The purpose of this prospective study was to directly compare 2 reverse shoulder arthroplasty designs. Two treatment groups and 1 control group were identified. Group I comprised 9 patients using a medialized Grammont-style (GRM) prosthesis with a neck-shaft angle of 155°. Group II comprised 9 patients using a lateralized (LAT) prosthesis with a neck-shaft angle of 135°. Pre- and postoperative assessment of range of motion, American Shoulder and Elbow Surgeons score, and visual analog scale pain score were performed. Radiographic measurements of lateral humeral offset and acromiohumeral distance were compared. The GRM prosthesis achieved greater forward flexion (143.9° vs 115.6°; P=.05), whereas the LAT achieved greater external rotation (35.0° vs 28.3°; P=.07). The lateral humeral offset was greater for the LAT prosthesis compared with the GRM prosthesis, but this distance was not significantly different from that found in the control group. The acromiohumeral distance was significantly greater in the GRM prosthesis group compared with both the LAT and the control groups. The results of this study confirm that different reverse shoulder arthroplasty designs produce radiographically different anatomy. Whereas the GRM prosthesis significantly alters the anatomy of the shoulder, the LAT design can preserve some anatomic relationships found in the normal shoulder. The clinical outcomes indicate that this may have an effect on range of motion, with traditional designs achieving greater forward flexion and lateralized designs achieving greater external rotation. PMID:26652330

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

  10. Lower Limbs Function and Pain Relationships after Unilateral Total Knee Arthroplasty

    ERIC Educational Resources Information Center

    Tali, Maie; Maaroos, Jaak

    2010-01-01

    The aim of the study was to evaluate gait characteristics, lower limbs joint function, and pain relationships associated with knee osteoarthritis of female patients before and 3 months after total knee arthroplasty at an outpatient clinic rehabilitation department. Gait parameters were registered, the active range of lower extremity joints was…

  11. Revision arthroplasty utilizing the Biomet Total Toe System for failed silicone elastomer implants.

    PubMed

    Koenig, R D

    1994-01-01

    The author presents a 3-year study of 10 cases of revisional arthroplasty utilizing the Biomet Total Toe System. The procedure is performed to eliminate pain and restore function in cases of metatarsophalangeal joint silicone elastomer implant failure. The surgeon should be familiar with the Total Toe System before attempting revision. PMID:8081327

  12. Oral Antibiotics are Effective for Highly Resistant Hip Arthroplasty Infections

    PubMed Central

    Esteban, Jaime; García-Cimbrelo, Eduardo

    2009-01-01

    Infected arthroplasties reportedly have a lower eradication rate when caused by highly resistant and/or polymicrobial isolates and in these patients most authors recommend intravenous antibiotics. We asked whether two-stage revision with interim oral antibiotics could eradicate these infections. We prospectively followed 36 patients (mean age, 71.8 years) with late hip arthroplasty infections. Combinations of oral antibiotics were prescribed according to cultures, biofilm, and intracellular effectiveness. The minimum followup was 1 year (mean, 4.4 years; range, 1–12 years). We presumed eradication in the absence of clinical, serologic, and radiographic signs of infection. Infection was eradicated in all 13 patients with highly resistant bacteria who completed a two-stage protocol (10 with methicillin-resistant Staphylococci) and in eight of 11 patients treated with only the first stage (and six of nine with methicillin-resistant Staphylococci). Infection was eradicated in six of six patients with polymicrobial isolates (of sensitive and/or resistant bacteria) who completed a two-stage protocol and in five of seven with polymicrobial isolates treated with only the first surgery. The Harris hip score averaged 88.1 (range, 70–98) in patients who underwent reimplantation and 56.8 (range, 32–76) in patients who underwent resection arthroplasty. Long cycles of combined oral antibiotics plus a two-stage surgical exchange appear a promising alternative for infections by highly resistant bacteria, methicillin-resistant Staphylococci, and polymicrobial infections. Level of Evidence: Level IV, prognostic study. See Guidelines for Authors for a complete description of levels of evidence. PMID:19333670

  13. Compartment syndrome after total knee arthroplasty: regarding a clinical case.

    PubMed

    Pinheiro, Ana Alexandra da Costa; Marques, Pedro Miguel Dantas Costa; Sá, Pedro Miguel Gomes; Oliveira, Carolina Fernandes; da Silva, Bruno Pombo Ferreira; de Sousa, Cristina Maria Varino

    2015-01-01

    Although compartment syndrome is a rare complication of total knee arthroplasty, it is one of the most devastating complications. It is defined as a situation of increased pressure within a closed osteofascial space that impairs the circulation and the functioning of the tissues inside this space, thereby leading to ischemia and tissue dysfunction. Here, a clinical case of a patient who was followed up in orthopedic outpatient consultations due to right gonarthrosis is presented. The patient had a history of arthroscopic meniscectomy and presented knee flexion of 10° before the operation, which consisted of total arthroplasty of the right knee. The operation seemed to be free from intercurrences, but the patient evolved with compartment syndrome of the ipsilateral leg after the operation. Since compartment syndrome is a true surgical emergency, early recognition and treatment of this condition through fasciotomy is crucial in order to avoid amputation, limb dysfunction, kidney failure and death. However, it may be difficult to make the diagnosis and cases may not be recognized if the cause of compartment syndrome is unusual or if the patient is under epidural analgesia and/or peripheral nerve block, which thus camouflages the main warning sign, i.e. disproportional pain. In addition, edema of the limb that underwent the intervention is common after total knee arthroplasty operations. This study presents a review of the literature and signals that the possible rarity of cases is probably due to failure to recognize this condition in a timely manner and to placing these patients in other diagnostic groups that are less likely, such as neuropraxia caused by using a tourniquet or peripheral nerve injury.

  14. PRELIMINARY EXPOSURE ASSESSMENT FINDINGS FROM THE TAMPA ASTHMATIC CHILDREN'S STUDY

    EPA Science Inventory

    The Tampa Asthmatic Children's Study (TACS) was a pilot study that focused on developing and evaluating air pollution exposure assessment methods and participant recruiting tools. The four-week study was performed in October and November, 2003. The study involved repeated daily...

  15. Metal-on-Metal Total Hip Resurfacing Arthroplasty

    PubMed Central

    2006-01-01

    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

  16. Systems design study of the Pioneer Venus spacecraft. Volume 2. Preliminary program development plan

    NASA Technical Reports Server (NTRS)

    1973-01-01

    The preliminary development plan for the Pioneer Venus program is presented. This preliminary plan treats only developmental aspects that would have a significant effect on program cost. These significant development areas were: master program schedule planning; test planning - both unit and system testing for probes/orbiter/ probe bus; ground support equipment; performance assurance; and science integration Various test planning options and test method techniques were evaluated in terms of achieving a low-cost program without degrading mission performance or system reliability. The approaches studied and the methodology of the selected approach are defined.

  17. Comparison of Direct Anterior and Lateral Approaches in Total Hip Arthroplasty

    PubMed Central

    Yue, Chen; Kang, Pengde; Pei, Fuxing

    2015-01-01

    Abstract The direct anterior approach (DAA) to total hip arthroplasty has been promoted as a minimally invasive alternative to the lateral approach, which we sought to verify by systematically reviewing and meta-analyzing the literature comparing clinical, radiographic, and surgical outcomes. Two reviewers independently searched PubMed, OVID, and Web of Science databases for randomized controlled trials (RCTs) and cohort studies comparing the DAA and lateral approach for total hip arthroplasty. Quality of RCTs was assessed using the Jadad scoring system, quality of cohort studies, using the Minors system. Data were extracted and meta-analyzed or qualitatively synthesized for primary outcomes (function, complications, and hospitalization time) and several secondary outcomes. Data were extracted from 12 trials involving 4901 arthroplasty procedures. Meta-analysis showed that DAA was associated with significantly shorter hospitalization than the lateral approach, as well as greater functional rehabilitation and lower perceived pain during the early postoperative period. On the other hand, DAA was associated with longer surgery time. The 2 approaches were associated with similar rates of perioperative surgical complications and transfusions, as well as similar radiographic analysis results. Although DAA may provide shorter hospitalization and faster recovery during the early postoperative period, the available evidence is still insufficient to conclude whether the DAA or lateral approach is superior for total hip arthroplasty. More high-quality studies and subsequent meta-analyses are needed. PMID:26683920

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

    PubMed

    Lew, Eric; Nicolosi, Nicole; McKee, Patrick

    2015-01-01

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

  19. PRELIMINARY HEALTH BURDEN ANALYSIS FOR EPIDEMIOLOGIC RECREATIONAL WATER STUDY

    EPA Science Inventory

    Introduction: The National Epidemiological and Environmental Assessment of Recreational Water Study (NEEAR) offers a rare opportunity for researchers. The study's design involves the collection of health data before and after visiting the beach in conjunction with water quality...

  20. Gait Analysis of Conventional Total Knee Arthroplasty and Bicruciate Stabilized Total Knee Arthroplasty Using a Triaxial Accelerometer.

    PubMed

    Tomite, Takenori; Saito, Hidetomo; Aizawa, Toshiaki; Kijima, Hiroaki; Miyakoshi, Naohisa; Shimada, Yoichi

    2016-01-01

    One component of conventional total knee arthroplasty is removal of the anterior cruciate ligament, and the knee after total knee arthroplasty has been said to be a knee with anterior cruciate ligament dysfunction. Bicruciate stabilized total knee arthroplasty is believed to reproduce anterior cruciate ligament function in the implant and provide anterior stability. Conventional total knee arthroplasty was performed on the right knee and bicruciate stabilized total knee arthroplasty was performed on the left knee in the same patient, and a triaxial accelerometer was fitted to both knees after surgery. Gait analysis was then performed and is reported here. The subject was a 78-year-old woman who underwent conventional total knee arthroplasty on her right knee and bicruciate stabilized total knee arthroplasty on her left knee. On the femoral side with bicruciate stabilized total knee arthroplasty, compared to conventional total knee arthroplasty, there was little acceleration in the x-axis direction (anteroposterior direction) in the early swing phase. Bicruciate stabilized total knee arthroplasty may be able to replace anterior cruciate ligament function due to the structure of the implant and proper anteroposterior positioning. PMID:27648328

  1. Gait Analysis of Conventional Total Knee Arthroplasty and Bicruciate Stabilized Total Knee Arthroplasty Using a Triaxial Accelerometer

    PubMed Central

    Saito, Hidetomo; Aizawa, Toshiaki; Miyakoshi, Naohisa; Shimada, Yoichi

    2016-01-01

    One component of conventional total knee arthroplasty is removal of the anterior cruciate ligament, and the knee after total knee arthroplasty has been said to be a knee with anterior cruciate ligament dysfunction. Bicruciate stabilized total knee arthroplasty is believed to reproduce anterior cruciate ligament function in the implant and provide anterior stability. Conventional total knee arthroplasty was performed on the right knee and bicruciate stabilized total knee arthroplasty was performed on the left knee in the same patient, and a triaxial accelerometer was fitted to both knees after surgery. Gait analysis was then performed and is reported here. The subject was a 78-year-old woman who underwent conventional total knee arthroplasty on her right knee and bicruciate stabilized total knee arthroplasty on her left knee. On the femoral side with bicruciate stabilized total knee arthroplasty, compared to conventional total knee arthroplasty, there was little acceleration in the x-axis direction (anteroposterior direction) in the early swing phase. Bicruciate stabilized total knee arthroplasty may be able to replace anterior cruciate ligament function due to the structure of the implant and proper anteroposterior positioning. PMID:27648328

  2. Gait Analysis of Conventional Total Knee Arthroplasty and Bicruciate Stabilized Total Knee Arthroplasty Using a Triaxial Accelerometer

    PubMed Central

    Saito, Hidetomo; Aizawa, Toshiaki; Miyakoshi, Naohisa; Shimada, Yoichi

    2016-01-01

    One component of conventional total knee arthroplasty is removal of the anterior cruciate ligament, and the knee after total knee arthroplasty has been said to be a knee with anterior cruciate ligament dysfunction. Bicruciate stabilized total knee arthroplasty is believed to reproduce anterior cruciate ligament function in the implant and provide anterior stability. Conventional total knee arthroplasty was performed on the right knee and bicruciate stabilized total knee arthroplasty was performed on the left knee in the same patient, and a triaxial accelerometer was fitted to both knees after surgery. Gait analysis was then performed and is reported here. The subject was a 78-year-old woman who underwent conventional total knee arthroplasty on her right knee and bicruciate stabilized total knee arthroplasty on her left knee. On the femoral side with bicruciate stabilized total knee arthroplasty, compared to conventional total knee arthroplasty, there was little acceleration in the x-axis direction (anteroposterior direction) in the early swing phase. Bicruciate stabilized total knee arthroplasty may be able to replace anterior cruciate ligament function due to the structure of the implant and proper anteroposterior positioning.

  3. The mid-term outcome of total ankle arthroplasty and ankle fusion in rheumatoid arthritis: a systematic review

    PubMed Central

    2013-01-01

    Background While arthrodesis is the standard treatment of a severely arthritic ankle joint, total ankle arthroplasty has become a popular alternative. This review provides clinical outcomes and complications of both interventions in patients with rheumatoid arthritis. Methods Studies were obtained from Pubmed, Embase and Web of Science (January 1980 – June 2011) and additional manual search. Inclusion criteria: original clinical study, > 5 rheumatoid arthritis (population), internal fixation arthrodesis or three-component mobile bearing prosthesis (intervention), ankle scoring system (outcome). The clinical outcome score, complication- and failure rates were extracted and the methodological quality of the studies was analysed. Results 17 observational studies of 868 citations were included. The effect size concerning total ankle arthroplasty ranged between 1.9 and 6.0, for arthrodesis the effect sizes were 4.0 and 4.7. Reoperation due to implant failure or reoperation due to non-union, was 11% and 12% for respectively total ankle arthroplasty and arthrodesis. The methodological quality of the studies was low (mean 6.4 out of a maximum of 14 points) and was lower for arthrodesis (mean 4.8) as compared to arthroplasty (mean 7.8) (p = 0.04). Conclusions 17 observational and no (randomized) controlled clinical trials are published on the effectiveness of arthroplasty or arthrodesis of the ankle in rheumatoid arthritis. Regardless of the methodological limitations it can be concluded that both interventions show clinical improvement and in line with current literature neither procedure is superior to the other. PMID:24161014

  4. The Status of Women in Alaska, 1977. A Preliminary Study.

    ERIC Educational Resources Information Center

    Jones, Dorothy M.; And Others

    To determine the precise nature and extent of the problem confronting Alaskan women, the Legislature in 1976 directed the Human Rights Commission to conduct a study on the status of women in education, employment, health, and the justice system. This publication contains the results of that study. Data for the study were secured through interviews…

  5. Implant Design in Cementless Hip Arthroplasty

    PubMed Central

    Kim, Jung Taek

    2016-01-01

    When performing cementless hip arthroplasty, it is critical to achieve firm primary mechanical stability followed by biological fixation. In order to achieve this, it is essential to fully understand characteristics of implant design. In this review, the authors review fixation principles for a variety of implants used for cementless hip replacement and considerations for making an optimal selection. PMID:27536647

  6. Assessing the Parents of Juvenile Offenders: A Preliminary Validation Study of the Juvenile Offender Parent Questionnaire

    ERIC Educational Resources Information Center

    Rose, Clark C.; Glaser, Brian A.; Calhoun, Georgia B.; Bates, Jeffrey M.

    2004-01-01

    The present study is a preliminary investigation into the development of a parent self-report instrument, the Juvenile Offender Parent Questionnaire (JOPQ). A large pool of items was rationally derived from a model of parent competency and then administered to 243 parents of children who were making appearances in juvenile court. Exploratory…

  7. School Library Support of Health Education in China: A Preliminary Study

    ERIC Educational Resources Information Center

    Liu, Geoffrey Z.; Zhang, Wuhong

    2008-01-01

    This preliminary study investigates the current situation of school library support of K-12 health education in China. A survey of 42 school librarians and 115 K-12 teachers from selected schools was conducted to find out their views about school library's role in school health education and their current practice of library use in health…

  8. Zero-gravity cloud physics laboratory: Experiment program definition and preliminary laboratory concept studies

    NASA Technical Reports Server (NTRS)

    Eaton, L. R.; Greco, E. V.

    1973-01-01

    The experiment program definition and preliminary laboratory concept studies on the zero G cloud physics laboratory are reported. This program involves the definition and development of an atmospheric cloud physics laboratory and the selection and delineations of a set of candidate experiments that must utilize the unique environment of zero gravity or near zero gravity.

  9. Factorial Structure of the Pain Rehabilitation Expectations Scale: A Preliminary Study

    ERIC Educational Resources Information Center

    Cheing, Gladys L. Y.; Lai, Amy K. M.; Vong, Sinfia K. S.; Chan, Fong H.

    2010-01-01

    The aim of this study was to report the preliminary validation results for the Pain Rehabilitation Expectations Scale (PRES). The PRES is a clinical tool developed to measure the expectations about rehabilitation treatment and outcome for people with back pain. Fifty people with chronic back pain were recruited from 11 physiotherapy outpatient…

  10. Comparison of Brain Activity during Drawing and Clay Sculpting: A Preliminary qEEG Study

    ERIC Educational Resources Information Center

    Kruk, Kerry A.; Aravich, Paul F.; Deaver, Sarah P.; deBeus, Roger

    2014-01-01

    A preliminary experimental study examined brain wave frequency patterns of female participants (N = 14) engaged in two different art making conditions: clay sculpting and drawing. After controlling for nonspecific effects of movement, quantitative electroencephalographic (qEEG) recordings were made of the bilateral medial frontal cortex and…

  11. Correlates of Cigarette Smoking among Male Chinese College Students in China--A Preliminary Study

    ERIC Educational Resources Information Center

    Li, Kaigang; Kay, Noy S.

    2009-01-01

    The main purpose of this preliminary study was to examine the association between four constructs of the Health Belief Model (HBM) (i.e. perceived severity of smoking-related health problems, perceived susceptibility to smoking-health related problems, perceived barriers to non-smoking and perceived benefits of non-smoking) and cigarette smoking …

  12. The Development of a Computer Model for Projecting Statewide College Enrollments: A Preliminary Study.

    ERIC Educational Resources Information Center

    Rensselaer Research Corp., Troy, NY.

    The purpose of this study was to develop the schema and methodology for the construction of a computerized mathematical model designed to project college and university enrollments in New York State and to meet the future increased demands of higher education planners. This preliminary report describes the main structure of the proposed computer…

  13. Work Experiences of People with Mental Illness in Malaysia: A Preliminary Qualitative Study

    ERIC Educational Resources Information Center

    Boo, Su-Lyn; Loong, Jaymee; Ng, Wai-Sheng

    2011-01-01

    This is a preliminary qualitative study, using a basic interpretive approach, to investigate the work experiences of people with mental illness in Malaysia. Six females and four males (aged 30-70) from a residential home for the mentally ill participated in semi-structured interviews. Three inter-relating themes emerged, namely the experience of…

  14. Factors affecting weight gain and dietary intake in Latino males residing in Mississippi: A preliminary study

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Research indicates that as Latinos become more acculturated to the United States, their diet changes and they experience weight gain. There is also a high incidence of depression in this population. The purpose of this preliminary study was to examine the correlations between sociodemographic factor...

  15. Validity and Reliability of Turkish Version of Gilliam Autism Rating Scale-2: Results of Preliminary Study

    ERIC Educational Resources Information Center

    Diken, Ibrahim H.; Diken, Ozlem; Gilliam, James E.; Ardic, Avsar; Sweeney, Dwight

    2012-01-01

    The purpose of this preliminary study was to explore the validity and reliability of Turkish Version of the Gilliam Autism Rating Scale-2 (TV-GARS-2). Participants included 436 children diagnosed with autism (331 male and 105 female, mean of ages was 8.01 with SD = 3.77). Data were also collected from individuals diagnosed with intellectual…

  16. A Preliminary Study of Teachers' Perceptions of Sex Education in Hong Kong Preschools

    ERIC Educational Resources Information Center

    Lai, Yuk Ching

    2006-01-01

    In Hong Kong, once a British colony, sex has traditionally been viewed as taboo and, as such, seldom talked about or openly discussed in public. As a result, there is reluctance on the part of most pre-to-secondary schools to implement sex education. The aim of this preliminary study was to investigate teachers' perceptions of preschool sex…

  17. Nd:YAG laser treatment of herpes and aphthous ulcers: a preliminary study

    NASA Astrophysics Data System (ADS)

    Parkins, Frederick M.; O'Toole, Thomas J.; Yancey, John M.

    2000-06-01

    Previously herpes labialis and recurrent aphthous ulcers have not been successfully treated. A preliminary study with a pulsed Nd:YAG laser evaluated the results with a protocol of four minute non-contact exposures for both types of lesions. Most patients experienced relief of symptoms. The progress of herpes lesion was halted and aphthous lesions became desensitized.

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

    PubMed Central

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

    2015-01-01

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

  19. Revision hip arthroplasty activity in a single UK health region: an audit of 1265 cases.

    PubMed Central

    Hassan, T.; Birtwistle, S.; Power, R. A.; Harper, W. M.

    2000-01-01

    Revision hip arthroplasty is an operation which is steadily increasing in number and can often be technically challenging. We have utilised a regional hip register (the Trent Regional Arthroplasty Study) to analyse the epidemiology of revision hip arthroplasties in a single UK health region. The study shows that of the large number (1265) of procedures performed over a 7-year period (1991-1997), the majority were performed by general orthopaedic surgeons, with 91 different surgeons performing the operation and only two surgeons performing more than 20 procedures per year. Of more than 100 prosthetic combinations used for the procedure, the Charnley prosthesis was the most common (38.3% of acetabular revisions and 37.5% of femoral revisions). The same component was also the most commonly explanted (43%). There was an even geographical spread across the region with revision hip arthroplasty being performed in all hospitals with an orthopaedic in-patient facility. Prospective audit of this large and varied cohort is necessary to determine differences in outcome (if any) between 'specialist' hip surgeons and general orthopaedic surgeons. Images Figure 1 PMID:10932666

  20. Pelvic Support Osteotomy in the Treatment of Patients With Excision Arthroplasty

    PubMed Central

    2008-01-01

    Resistant hip infection in adults can be a complicated problem that does not respond to surgical and medical treatment. In such cases, the only remaining option is excision arthroplasty. This line of treatment can eradicate the infection but also is associated with poor function. In some cases, conversion of excision arthroplasty to artificial joint replacement is associated with too great a risk because of local hip surgical risks or low immunity with risk of recurrent infection. Pelvic support osteotomy with the Ilizarov modification can present an alternative solution for such patients. This study included 11 patients with resistant hip infection who were treated using excision arthroplasty. Pelvic support osteotomy then was used to improve hip stability and abductor muscle function. The Ilizarov modification was applied to correct mechanical alignment of the limb and the limb length discrepancy. Harris hip scores improved in all patients: the average score preoperatively was 43.5 (range, 31–50), whereas at final followup, the average score was 70.9 (range, 65–80). Pelvic support osteotomy, along with the Ilizarov modification, can provide an alternative treatment to improve function in patients previously managed with excision hip arthroplasty and Girdlestone surgery. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18264860

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

    PubMed

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

    2015-03-01

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

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

    PubMed Central

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

    2015-01-01

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

  3. Young Children's Perceptions of Scientists: A Preliminary Study

    ERIC Educational Resources Information Center

    Buldu, Mehmet

    2006-01-01

    Background: Since the 1950s, there has been a growing body of research dealing with perceptions children have of scientists. Typically, research studies in this area have utilized children's drawings in an effort to discern what those perceptions are. Studies assessing perceptions children have of scientists have shown that children have…

  4. Supporting Off-Shore Students: A Preliminary Study

    ERIC Educational Resources Information Center

    Hussin, Virginia

    2007-01-01

    This paper reports on the first part of a recent research study into current initiatives to support the learning of non-English speaking background (NESB) transnational students in Asia who are studying off-shore at Australian universities. Learning support and development staff in 12 universities were surveyed using a questionnaire. The survey…

  5. Citations to Wikipedia in Chemistry Journals: A Preliminary Study

    ERIC Educational Resources Information Center

    Brazzeal, Bradley

    2011-01-01

    Wikipedia has been the subject of an increasing number of studies. Many of these have focused on the quality of Wikipedia articles and the use of Wikipedia by students. Little research has focused on the use of Wikipedia by scholars. This study helps to fill that gap by examining citations to Wikipedia in chemistry journals from three major…

  6. Synovial cutaneous fistula complicating a reverse total shoulder arthroplasty.

    PubMed

    Letter, Haley P; Limback, Joseph; Wasyliw, Christopher; Bancroft, Laura; Scherer, Kurt

    2016-06-01

    Reverse total shoulder arthroplasty is becoming a common form of shoulder arthroplasty that is often performed in the setting of rotator cuff pathology. Infection is a rare complication but is more common in reverse total shoulder arthroplasty than in hemiarthroplasty or anatomic total shoulder arthroplasty. We present the case of a 69-year-old patient with a reverse total shoulder arthroplasty who presented with purulent drainage from the skin of his anterior shoulder. Computed tomography arthrogram confirmed the presence of a synovial cutaneous fistula. Synovial cutaneous fistula is a rare variant of periprosthetic infection that, to our knowledge, has not been described previously in the setting of a reverse total shoulder arthroplasty. Computed tomography arthrogram proved to be a reliable method for confirming the diagnosis and was used for operative planning to remove the hardware. PMID:27257460

  7. Disciplinary Culture, Bibliometrics, and Historical Studies: Preliminary Observations.

    ERIC Educational Resources Information Center

    Buchanan, Anne L.; Herubel, Jean-Pierre V. M.

    1997-01-01

    Discusses bibliometrics and its relationship to historical studies in order to examine community formation of scientific and scholarly communication through institutional affiliation. A history journal is investigated and reveals an institutional and geographical mapping of the contributors. (Author/LRW)

  8. Numerical aerodynamic simulation facility preliminary study, volume 2 and appendices

    NASA Technical Reports Server (NTRS)

    1977-01-01

    Data to support results obtained in technology assessment studies are presented. Objectives, starting points, and future study tasks are outlined. Key design issues discussed in appendices include: data allocation, transposition network design, fault tolerance and trustworthiness, logic design, processing element of existing components, number of processors, the host system, alternate data base memory designs, number representation, fast div 521 instruction, architectures, and lockstep array versus synchronizable array machine comparison.

  9. Popliteal Artery Pseudoaneurysm Following Primary Total Knee Arthroplasty

    PubMed Central

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

    2014-01-01

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

  10. Mycobacterium smegmatis infection of a prosthetic total knee arthroplasty.

    PubMed

    Saffo, Zaid; Ognjan, Anthony

    2016-01-01

    The most common organisms causing prosthetic knee joint infections are staphylococci. However, arthroplasty infections with atypical microbial pathogens, such as Mycobacteria can occur. Due to the rarity of mycobacterial prosthetic joint infections, diagnosis, treatment, and management of these atypical infections represent a clinical challenge. A 71-year old female post-operative day 40 after a left total knee arthroplasty was hospitalized secondary to left knee pain and suspected arthroplasty infection. She had failed outpatient oral antimicrobial treatment for superficial stitch abscess; and outpatient IV/Oral antimicrobials for a clinical postoperative septic bursitis. Ultimately, resection arthroplasty with operative tissue acid fast bacterial cultures demonstrated growth of the Mycobacterium smegmatis group. Post-operatively, she completed a combination course of oral doxycycline and levofloxacin and successfully completed a replacement arthroplasty with clinical and microbial resolution of the infection. To our knowledge, literature review demonstrates three case of knee arthroplasty infection caused by the Mycobacterium smegmatis group. Correspondingly, optimal surgical procedures and antimicrobial management including antimicrobial selection, treatment duration are not well defined. Presently, the best treatment options consists of two step surgical management including prosthesis hardware removal followed by extended antimicrobial therapy, followed by consideration for re-implantation arthroplasty. Our case illustrates importance of considering atypical mycobacterial infections in post-operative arthroplasty infections not responding to traditional surgical manipulations and antimicrobials. For an arthroplasty infection involving the atypical Mycobacterium smegmatis group, two step arthroplasty revision, including arthroplasty resection, with a combination of oral doxycycline and levofloxacin can lead to successful infection resolution, allowing for a

  11. Accumulation in liver and spleen of metal particles generated at nonbearing surfaces in hip arthroplasty.

    PubMed

    Urban, Robert M; Tomlinson, Michael J; Hall, Deborah J; Jacobs, Joshua J

    2004-12-01

    Systemic migration of metal particles generated at nonbearing surfaces rather than the intended primary bearing was studied in postmortem specimens from 30 patients with total hip arthroplasty. Using light and electron microscopy with x-ray microanalysis, submicrometer metal particles were identified within macrophages in the liver and/or the spleen in 11 of 15 patients with a revised arthroplasty and in 2 of 15 patients with primary hip arthroplasty. The macrophages formed focal aggregates in the organs without apparent toxicity. Fretting at ancillary fixation devices, loose components, and modular connections can generate a substantial volume of debris. These particles are in addition to those generated at the bearing surfaces, further increasing both the local and systemic particulate burdens. While all components can be associated with the distant spread of particles and metal ions, it is the environment of revision arthroplasty that provides the greatest potential for the generation and systemic dissemination of wear debris. The long-term effects of accumulated wear particles in the liver and spleen are unknown. PMID:15578561

  12. Venous thromboembolism prophylaxis after total hip or knee arthroplasty: a survey of Canadian orthopedic surgeons

    PubMed Central

    Gross, Michael; Anderson, David R.; Nagpal, Seema; O’Brien, Bernie

    1999-01-01

    Objective To determine the pharmacologic and physical modalities used by orthopedic surgeons in Canada to prevent venous thromboembolism (deep venous thrombosis and pulmonary embolism) after total hip or knee arthroplasty. Design Mail survey sent to all members of the Canadian Orthopaedic Association. Setting A nation-wide study. Methods A total of 828 questionnaires, designed to identify the type and frequency of prophylaxis against venous thromboembolism that were used after hip and knee arthroplasty were mailed to orthopedic surgeons. Outcome measures Demographic data and the frequency and type of thromboprophylaxis. Results Of the 828 surveys mailed 445 (54%) were returned, and 397 were included in this analysis. Of the respondents, 97% used prophylaxis routinely for patients who undergo total hip or knee arthroplasty. Three of the 397 (0.8%) did not use any method of prophylaxis. Warfarin was the most common agent used (46%), followed by low-molecular-weight heparin (LMWH) (36%). Combination therapy with both mechanical and pharmacologic methods were used in 39% of patients. Objective screening tests were not frequently performed before discharge. Extended prophylaxis beyond the duration of hospitalization was used by 36% of physicians. Conclusion Prophylaxis for venous thromboembolism with warfarin or LMWH has become standard care after total hip or knee arthroplasty in Canada. PMID:10593248

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

    PubMed

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

    2012-10-01

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

  14. Role of negative pressure wound therapy in total hip and knee arthroplasty

    PubMed Central

    Siqueira, Marcelo BP; Ramanathan, Deepak; Klika, Alison K; Higuera, Carlos A; Barsoum, Wael K

    2016-01-01

    Negative-pressure wound therapy (NPWT) has been a successful modality of wound management which is in widespread use in several surgical fields. The main mechanisms of action thought to play a role in enhancing wound healing and preventing surgical site infection are macrodeformation and microdeformation of the wound bed, fluid removal, and stabilization of the wound environment. Due to the devastating consequences of infection in the setting of joint arthroplasty, there has been some interest in the use of NPWT following total hip arthroplasty and total knee arthroplasty. However, there is still a scarcity of data reporting on the use of NPWT within this field and most studies are limited by small sample sizes, high variability of clinical settings and end-points. There is little evidence to support the use of NPWT as an adjunctive treatment for surgical wound drainage, and for this reason surgical intervention should not be delayed when indicated. The prophylactic use of NPWT after arthroplasty in patients that are at high risk for postoperative wound drainage appears to have the strongest clinical evidence. Several clinical trials including single-use NPWT devices for this purpose are currently in progress and this may soon be incorporated in clinical guidelines as a mean to prevent periprosthetic joint infections. PMID:26807353

  15. Assessing interpersonal aspects of schizoid personality disorder: preliminary validation studies.

    PubMed

    Kosson, David S; Blackburn, Ronald; Byrnes, Katherine A; Park, Sohee; Logan, Caroline; Donnelly, John P

    2008-03-01

    In 2 studies, we examined the reliability and validity of an interpersonal measure of schizoid personality disorder (SZPD) based on nonverbal behaviors and interpersonal interactions occurring during interviews. A total of 556 male jail inmates in the United States participated in Study 1; 175 mentally disordered offenders in maximum security hospitals in the United Kingdom participated in Study 2. Across both samples, scores on the Interpersonal Measure of Schizoid Personality Disorder (IM-SZ) exhibited adequate reliability and patterns of correlations with other measures consistent with expectations. The scale displayed patterns of relatively specific correlations with interview and self-report measures of SZPD. In addition, the IM-SZ correlated in an expected manner with features of psychopathy and antisocial personality and with independent ratings of interpersonal behavior. We address implications for assessment of personality disorder.

  16. Preliminary cutting and drilling studies using new generation lasers

    SciTech Connect

    Kautz, D.D.; Sze, J.S.; Dragon, E.P.; Hargrove, R.S.

    1992-02-20

    High power and radiance dye lasers developed at Lawrence Livermore National Laboratory show promise for material processing tanks. Evaluation using welding heat flow models suggest significant increases in precision and speed are expected. We developed tooling and instrumentation to diagnose important parameters including spot geometry and optical train quality. We started processing studies to determine the viability of these lasers of cutting and drilling. We used titanium alloys first in the studies due to the availability of comparable parametric studies in the technical literature. Results show that cuts and holes with extremely fine features can be made with dye lasers. The high radiance beam produces low distortion and small heat-affected zones. We have accomplished very high aspect ratios and micron scale kerfs and holes. Through continued system improvement and process optimization, we believe that submicron levels will be achieved.

  17. Hydrogen Gas Retention and Release from WTP Vessels: Summary of Preliminary Studies

    SciTech Connect

    Gauglitz, Phillip A.; Bontha, Jagannadha R.; Daniel, Richard C.; Mahoney, Lenna A.; Rassat, Scot D.; Wells, Beric E.; Bao, Jie; Boeringa, Gregory K.; Buchmiller, William C.; Burns, Carolyn A.; Chun, Jaehun; Karri, Naveen K.; Li, Huidong; Tran, Diana N.

    2015-07-01

    The Hanford Waste Treatment and Immobilization Plant (WTP) is currently being designed and constructed to pretreat and vitrify a large portion of the waste in the 177 underground waste storage tanks at the Hanford Site. A number of technical issues related to the design of the pretreatment facility (PTF) of the WTP have been identified. These issues must be resolved prior to the U.S. Department of Energy (DOE) Office of River Protection (ORP) reaching a decision to proceed with engineering, procurement, and construction activities for the PTF. One of the issues is Technical Issue T1 - Hydrogen Gas Release from Vessels (hereafter referred to as T1). The focus of T1 is identifying controls for hydrogen release and completing any testing required to close the technical issue. In advance of selecting specific controls for hydrogen gas safety, a number of preliminary technical studies were initiated to support anticipated future testing and to improve the understanding of hydrogen gas generation, retention, and release within PTF vessels. These activities supported the development of a plan defining an overall strategy and approach for addressing T1 and achieving technical endpoints identified for T1. Preliminary studies also supported the development of a test plan for conducting testing and analysis to support closing T1. Both of these plans were developed in advance of selecting specific controls, and in the course of working on T1 it was decided that the testing and analysis identified in the test plan were not immediately needed. However, planning activities and preliminary studies led to significant technical progress in a number of areas. This report summarizes the progress to date from the preliminary technical studies. The technical results in this report should not be used for WTP design or safety and hazards analyses and technical results are marked with the following statement: “Preliminary Technical Results for Planning – Not to be used for WTP Design

  18. Migration and head penetration of Vitamin-E diffused cemented polyethylene cup compared to standard cemented cup in total hip arthroplasty: study protocol for a randomised, double-blind, controlled trial (E1 HIP)

    PubMed Central

    Sköldenberg, Olof; Rysinska, Agata; Chammout, Ghazi; Salemyr, Mats; Muren, Olle; Bodén, Henrik; Eisler, Thomas

    2016-01-01

    Introduction In vitro, Vitamin-E-diffused, highly cross-linked polyethylene (PE) has been shown to have superior wear resistance and improved mechanical properties when compared to those of standard highly cross-linked PE liners used in total hip arthroplasty (THA). The aim of the study is to evaluate the safety of a new cemented acetabular cup with Vitamin-E-doped PE regarding migration, head penetration and clinical results. Methods and analysis In this single-centre, double-blinded, randomised controlled trial, we will include 50 patients with primary hip osteoarthritis scheduled for THA and randomise them in a 1:1 ratio to a cemented cup with either argon gas-sterilised PE (control group) or Vitamin-E-diffused PE (vitamin-e group). All patients and the assessor of the primary outcome will be blinded and the same uncemented stem will be used for all participants. The primary end point will be proximal migration of the cup at 2 years after surgery measured with radiostereometry. Secondary end points include proximal migration at other follow-ups, total migration, femoral head penetration, clinical outcome scores and hip-related complications. Patients will be followed up at 3 months and at 1, 2, 5 and 10 years postoperatively. Results Results will be analysed using 95% CIs for the effect size. A regression model will also be used to adjust for stratification factors. Ethics and dissemination The ethical committee at Karolinska Institutet has approved the study. The first results from the study will be disseminated to the medical community via presentations and publications in relevant medical journals when the last patient included has been followed up for 2 years. Trial registration number NCT02254980. PMID:27388352

  19. Computer-Generated Geometry Instruction: A Preliminary Study

    ERIC Educational Resources Information Center

    Kang, Helen W.; Zentall, Sydney S.

    2011-01-01

    This study hypothesized that increased intensity of graphic information, presented in computer-generated instruction, could be differentially beneficial for students with hyperactivity and inattention by improving their ability to sustain attention and hold information in-mind. To this purpose, 18 2nd-4th grade students, recruited from general…

  20. Theoretical Evaluation Self-Test (Test): A Preliminary Validation Study

    ERIC Educational Resources Information Center

    Coleman, Daniel

    2004-01-01

    Over nearly 40 years, several scales have been developed to measure therapist theoretical orientation (Poznanski & McLennan, 1995). This study, unlike previous efforts, focuses on "community clinicians"--social workers and other mental health professionals (such as psychologists, counselors, psychiatrists, and psychiatric nurses) who work in…

  1. Methods Courses, So What? Preliminary Findings of a Longitudinal Study.

    ERIC Educational Resources Information Center

    Meyer, Richard J.; Flores-Duenas, Leila; Rossi, Pamela

    This study examined influences that preservice literacy teacher education courses and sustained relationships with literacy researchers had on the literacy practices of three preservice teachers during student teaching and their subsequent self-efficacy and performance as literacy teachers during their first teaching years. Data collected during…

  2. From Numbers to Action: A Preliminary Study of Retention.

    ERIC Educational Resources Information Center

    Greenlee, Shelia Parker; Greenlee, Harry

    This study examined retention at Christopher Newport University (CNU) in Newport News, Virginia, focusing on the demographic characteristics of those students who left the university as well as the reasons why they left. A total of 159 students who had attended CNU during the 1994-95 academic year but who did not re-enroll in the fall of 1995 were…

  3. Burnout among Special Education Administrators: A Preliminary Study

    ERIC Educational Resources Information Center

    Carter, Susan J.

    2011-01-01

    Research on the extent of stress and burnout among special education administrators is not as well developed as research on the extent of stress and burnout among teachers. This study utilized the Maslach Burnout Inventory to determine levels of stress and burnout among administrators of special education. Results indicated administrators of…

  4. Experimental Treatment of Early Stuttering: A Preliminary Study

    ERIC Educational Resources Information Center

    Franken, Marie-Christine J.; Kielstra-Van der Schalk, Carine J.; Boelens, Harrie

    2005-01-01

    This pilot study compared two treatments for stuttering in preschool-age children. Thirty children were randomly assigned to either a Lidcombe Program (LP) treatment or a Demands and Capacities Model (DCM) treatment. Stuttering frequencies and severity ratings were obtained immediately before and after treatment (12 weeks). The stuttering…

  5. Violence Prevention in Middle School: A Preliminary Study

    ERIC Educational Resources Information Center

    KIllam, Wendy K.; Roland, Catherine B.; Weber, Bill

    2014-01-01

    Violence in schools continues reflecting violence within society. There is a growing need for violence prevention programs within the schools that provide students with the skills needed to cope with interpersonal and relationship is-sues effectively. This study was conducted at a middle school and there were 345 middle school students (6th to 8th…

  6. Problems of Eskimo Relocation for Industrial Employment. A Preliminary Study.

    ERIC Educational Resources Information Center

    Stevenson, D. S.

    A study was conducted to determine the reasons for variable success in relocating Eskimo families from rural areas of the northern territories of Canada to southern centers of industrial employment (railways, mining centers). The data were collected by interviewing 105 Eskimos, both male and female, married and single, who had migrated south. The…

  7. Preliminary lithostratigraphic correlation study in OAPEC member countries

    SciTech Connect

    Lababidi, M.M.; Hamdan, A.N.

    1985-01-01

    This book examines a study correlating rock units in the Middle Eastern and North African member countries, based on direct information from the members. It comprises Paleozoic, Mesozoic, and Cenozoic correlation charts for each region and a lexicon giving the definition, age, lithology, and equivalents of each formation.

  8. Preliminary Systems Design Study assessment report. Volume 8, Appendixes

    SciTech Connect

    Mayberry, J.L.; Feizollahi, F.; Del Signore, J.C.

    1992-01-01

    The System Design Study (SDS), part of the Waste Technology Development Department at the Idaho National Engineering Laboratory (INEL), examined techniques available for the remediation of hazardous and transuranic waste stored at the Radioactive Waste Management Complex`s Subsurface Disposal Area at the INEL. Using specific technologies, system concepts for treating the buried waste and the surrounding contaminated soil were evaluated. Evaluation included implementability, effectiveness, and cost. The SDS resulted in the development of technology requirements including demonstration, testing, and evaluation activities needed for implementing each concept. This volume of the Systems Design Study contain four Appendixes that were part of the study. Appendix A is an EG&G Idaho, Inc., report that represents a review and compilation of previous reports describing the wastes and quantities disposed in the Subsurface Disposal Area of the Idaho National Engineering Laboratory. Appendix B contains the process flowsheets considered in this study, but not selected for detailed analysis. Appendix C is a historical tabulation of radioactive waste incinerators. Appendix D lists Department of Energy facilities where cementation stabilization systems have been used.

  9. Functional Communication Training in Rett Syndrome: A Preliminary Study

    ERIC Educational Resources Information Center

    Byiers, Breanne J.; Dimian, Adele; Symons, Frank J.

    2014-01-01

    Rett syndrome (RTT) is associated with a range of serious neurodevelopmental consequences including severe communicative impairments. Currently, no evidence-based communication interventions exist for the population (Sigafoos et al., 2009). The purpose of the current study was to examine the effectiveness of functional assessment (FA) and…

  10. Renal denervation by intravascular ultrasound: Preliminary in vivo study

    NASA Astrophysics Data System (ADS)

    Sinelnikov, Yegor; McClain, Steve; Zou, Yong; Smith, David; Warnking, Reinhard

    2012-10-01

    Ultrasound denervation has recently become a subject of intense research in connection with the treatment of complex medical conditions including neurological conditions, development of pain management, reproduction of skin sensation, neuropathic pain and spasticity. The objective of this study is to investigate the use of intravascular ultrasound to produce nerve damage in renal sympathetic nerves without significant injury to the renal artery. This technique may potentially be used to treat various medical conditions, such as hypertension. The study was approved by the Institutional Animal Care and Use Committee. Ultrasound was applied to renal nerves of the swine model for histopathological evaluation. Therapeutic ultrasound energy was delivered circumferentially by an intravascular catheter maneuvered into the renal arteries. Fluoroscopic imaging was conducted pre-and post-ultrasound treatment. Animals were recovered and euthanized up to 30 hours post procedure, followed by necropsy and tissue sample collection. Histopathological examination showed evidence of extensive damage to renal nerves, characterized by nuclear pyknosis, hyalinization of stroma and multifocal hemorrhages, with little or no damage to renal arteries. This study demonstrates the feasibility of intravascular ultrasound as a minimally invasive renal denervation technique. Further studies are necessary to evaluate the long-term safety and efficacy of this technique and its related clinical significance.

  11. Unicondylar knee arthroplasty: a cementless perspective

    PubMed Central

    Forsythe, Michael E.; Englund, Roy E.; Leighton, Ross K.

    2000-01-01

    Objective To compare the results of cementless unicondylar knee arthroplasty (UKA) with those already reported in a similar study on cemented UKA. Design A case-series cross-sectional study. Setting The Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax. Patients Fifty-one patients who underwent a total of 57 UKAs between May 1989 and May 1997. Inclusion criteria were osteoarthritis involving the predominantly the medial compartment of the knee, relative sparing of the other compartments, less than 15° of varus, minimal knee instability, and attendance at the postoperative clinical visit. Intervention Cementless UKA. Main outcome measures Clinical parameters that included pain, range of motion and the Knee Society Clinical Knee Score. Roentgenographic parameters that included α, β, γ and σ angles and the presence of periprosthetic radiolucency or loose beads. Results Age, weight, gender and follow-up interval did not significantly affect the clinical results in terms of pain, range of motion or knee score. Knees with more than 1 mm of radiolucency had significantly lower knee scores than those with no radiolucency. Knees that radiologically had loose beads also had significantly lower knee scores. The clinical outcomes of cementless UKA were comparable to those already reported on cemented UKA. Cementless femurs had less radiolucency than the cemented femurs, whereas cementless tibias had more radiolucency than their cemented counterparts. Conclusions Cementless UKA seems to be as efficacious as cemented UKA. However, there is some concern about the amount of radiolucency in the cementless tibial components. A randomized clinical trial comparing both cementless and cemented tibial components with a cementless femur (hybrid knee) is needed to further assess this controversial issue in UKA. PMID:11129829

  12. Periprosthetic Bone Remodelling in Total Knee Arthroplasty

    PubMed Central

    GEORGEANU, Vlad; ATASIEI, Tudor; GRUIONU, Lucian

    2014-01-01

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

  13. Functional outcome after successful internal fixation versus salvage arthroplasty of patients with a femoral neck fracture

    PubMed Central

    Zielinski, Stephanie M.; Keijsers, Noël L.; Praet, Stephan F.E.; Heetveld, Martin J.; Bhandari, Mohit; Wilssens, Jean Pierre; Patka, Peter; Van Lieshout, Esther M.M.

    2014-01-01

    Objectives To determine patient independency, health-related and disease-specific quality of life (QOL), gait pattern, and muscle strength in patients after salvage arthroplasty for failed internal fixation of a femoral neck fracture. Design Secondary cohort study to a randomized controlled trial. Setting Multicenter trial in the Netherlands, including 14 academic and non-academic hospitals Patients Patients after salvage arthroplasty for failed internal fixation of a femoral neck fracture were studied. A comparison was made with patients who healed uneventfully after internal fixation. Intervention None (observatory study) Main outcome measurements Patient characteristics, SF-12, and WOMAC scores were collected. Gait parameters were measured using plantar pressure measurement. Maximum isometric forces of the hip muscles were measured using a handheld dynamometer. Differences between the fractured and contralateral leg were calculated. Groups were compared using univariate analysis. Results Of 248 internal fixation patients (median age 72 years), salvage arthroplasty was performed in 68 patients (27%). Salvage arthroplasty patients had a significantly lower WOMAC score (median 73 versus 90, P=0.016) than patients who healed uneventfully after internal fixation. Health-related QOL (SF-12) and patient independency did not differ significantly between the groups. Gait analysis showed a significantly impaired progression of the center of pressure in the salvage surgery patients (median ratio −8.9 versus 0.4, P=0.013) and a significant greater loss of abduction strength (median −25.4 versus −20.4 N, P=0.025). Conclusion Despite a similar level of dependency and QOL, salvage arthroplasty patients have inferior functional outcome than patients who heal after internal fixation of a femoral neck fracture. PMID:24835623

  14. Unexpected wear of an unicompartimental knee arthroplasty in oxidized zirconium.

    PubMed

    Luyet, Anais; Fischer, Jean-François; Jolles, Brigitte M; Lunebourg, Alexandre

    2015-12-01

    Unicompartimental knee arthroplasty is a successful procedure for the treatment of localized osteoarthritis to one compartment of the knee with good long-term results. However, several modes of failure of unicompartimental knee arthroplasty have been described, namely aseptic or septic loosening, progression of disease, wear, and instability. Metallosis after unicompartimental knee arthroplasty is rarely reported and is most often related with polyethylene wear or break. We report on a case of rapid failure of unicompartimental knee arthroplasty in oxidized zirconium associated with metallosis secondary to the dislocation of the polyethylene.

  15. Addressing glenoid erosion in reverse total shoulder arthroplasty.

    PubMed

    Gilot, Gregory J

    2013-01-01

    Severe glenoid wear is technically problematic, has a higher complication rate, and inferior results in the setting of shoulder arthroplasty. This paper introduces four basic strategies for treating glenoid erosion with a reverse shoulder arthroplasty which include; 1. eccentric reaming, 2. bone grafting of glenoid, 3. reaming and bone grafting, and 4. using augmented baseplates. The benefits and shortcomings of each of these techniques are discussed. The reverse shoulder arthroplasty has many advantages over anatomic shoulder arthroplasty when dealing with severe glenoid defects. Augmented baseplates are new and allow the surgeon to treat various different glenoid defects with preservation of glenoid subchondral bone. PMID:24328581

  16. Advanced Analysis of Finger-Tapping Performance: A Preliminary Study

    PubMed Central

    Barut, Çağatay; Kızıltan, Erhan; Gelir, Ethem; Köktürk, Fürüzan

    2013-01-01

    Background: The finger-tapping test is a commonly employed quantitative assessment tool used to measure motor performance in the upper extremities. This task is a complex motion that is affected by external stimuli, mood and health status. The complexity of this task is difficult to explain with a single average intertap-interval value (time difference between successive tappings) which only provides general information and neglects the temporal effects of the aforementioned factors. Aims: This study evaluated the time course of average intertap-interval values and the patterns of variation in both the right and left hands of right-handed subjects using a computer-based finger-tapping system. Study Design: Cross sectional study. Methods: Thirty eight male individuals aged between 20 and 28 years (Mean±SD = 22.24±1.65) participated in the study. Participants were asked to perform single-finger-tapping test for 10 seconds of test period. Only the results of right-handed (RH) 35 participants were considered in this study. The test records the time of tapping and saves data as the time difference between successive tappings for further analysis. The average number of tappings and the temporal fluctuation patterns of the intertap-intervals were calculated and compared. The variations in the intertap-interval were evaluated with the best curve fit method. Results: An average tapping speed or tapping rate can reliably be defined for a single-finger tapping test by analysing the graphically presented data of the number of tappings within the test period. However, a different presentation of the same data, namely the intertap-interval values, shows temporal variation as the number of tapping increases. Curve fitting applications indicate that the variation has a biphasic nature. Conclusion: The measures obtained in this study reflect the complex nature of the finger-tapping task and are suggested to provide reliable information regarding hand performance. Moreover, the

  17. Sleep habits and patterns of college students: a preliminary study.

    PubMed

    Buboltz, W C; Brown, F; Soper, B

    2001-11-01

    The negative effects of sleep difficulties have been well documented. However, the prevalence of such problems among US college students has not been well studied. Design difficulties are common in the limited number of existing investigations, making it difficult to estimates the prevalence and types of disturbance studied. The authors describe the use of a quantitative-based assessment instrument to provide an initial indication of students' sleep problems and to serve as a means of addressing some of the deficiencies in the literature. In their sample of 191 undergraduates at a rural southern university, they found that most of the students exhibited some form of sleep disturbance and that women, in general, reported more sleep disturbances than men did. They suggest how colleges and university officials can alter procedures to minimize students' sleep disturbances and reduce the deleterious effects of sleep problems on academic performance. PMID:11765249

  18. Naked foot marks - a preliminary study of identification factors.

    PubMed

    Qamra, S R; Sharma, B P; Kaila, P

    1980-01-01

    Footprints of 725 apparently healthy subjects (395 males and 330 females) between the ages of 18 and 30 years were obtained. A number of measurements were taken on each footprint and converted into suitable indices to overcome the problems of registration, recording and observation. Minimum and maximum probability values for each index and combined probabilities were calculated. From the data, it was found that the maximum combined frequency of an individual in the population was of the order of 10(-4) and the minimum combined consideration crease marks and other characteristic features. Thus the present study indicates that combined probabilities could provide reasonably reliable circumstantial evidence to link the criminal with the crime. Humps and creases, which often confer individuality on a print, form additional features of the study.

  19. Promotion of mindfulness in psychotherapists in training: preliminary study.

    PubMed

    Grepmair, Ludwig; Mitterlehner, Ferdinand; Loew, Thomas; Nickel, Marius

    2007-11-01

    This study examined whether the promotion of mindfulness in psychotherapists in training can influence the treatment results of their patients. The therapeutic course and treatment results of 196 inpatients, who were treated during a nine week period by nine psychotherapists in training, were compared: in the first phase of the study, the treatment group without (CG, historical control group, n=55), and in the second phase the treatment group with, (MFG, n=58) therapists who were currently practicing Zen meditation. The results of treatment were examined (according to the intent-to-treat principle) with the Session Questionnaire for General and Differential Individual Psychotherapy (STEP), the Questionnaire of Changes in Experience and Behaviour (VEV) and the Symptom Checklist (SCL-90-R), and showed significantly better results in the MFG.

  20. Gravity of the New Madrid seismic zone; a preliminary study

    USGS Publications Warehouse

    Langenheim, V.E.

    1995-01-01

    In the winter of 1811-12, three of the largest historic earthquakes in the United States occurred near New Madrid, Mo. Seismicity continues to the present day throughout a tightly clustered pattern of epicenters centered on the bootheel of Missouri, including parts of northeastern Arkansas, northwestern Tennessee, western Kentucky, and southern Illinois. In 1990, the New Madrid seismic zone/Central United States became the first seismically active region east of the Rocky Mountains to be designated a priority research area within the National Earthquake Hazards Reduction Program (NEHRP). This Professional Paper is a collection of papers, some published separately, presenting results of the newly intensified research program in this area. Major components of this research program include tectonic framework studies, seismicity and deformation monitoring and modeling, improved seismic hazard and risk assessments, and cooperative hazard mitigation studies.

  1. Preliminary cutting and drilling studies using new generation lasers

    SciTech Connect

    Kautz, D.D.; Sze, J.S.; Dragon, E.P.; Hargrove, R.S.

    1992-02-20

    High power and radiance dye lasers developed at Lawrence Livermore National Laboratory show promise for material processing tasks. Evaluation using welding heat flow models suggests significant increases in precision and speed are expected. We developed tooling and instrumentation to diagnose important parameters including spot geometry and optical train quality. We started processing studies to determine the viability of these lasers for cutting and drilling. We used titanium and stainless steel alloys for testing due to the availability of comparable parametric studies in the technical literature. Results show that cuts and holes with extremely fine features can be made with dye lasers. The high radiance beam produces low distortion and small heat-affected zone. We have accomplished very high aspects ratios and micron scale kerfs and holes. Through continued system improvement and process optimization, we believe that submicron levels will be realized.

  2. Preliminary results from two international pluvial flood event studies

    NASA Astrophysics Data System (ADS)

    Roezer, Viktor; Spekkers, Matthieu; Kreibich, Heidi

    2016-04-01

    Pluvial floods have caused severe damages to urban dwellings in Europe and elsewhere in recent years. With a predicted increase in extreme weather events as well as an ongoing urbanization, pluvial flood damage is expected to increase in the future. These type of flood events, caused by stormwater being unable to enter urban drainage systems or flowing out of urban drainage systems when capacity is exceeded, often happen with little warning and in areas which are often not obviously prone to flooding. Up to now little research was done on the adverse consequences of pluvial floods, as empirical damage data of pluvial flooding is scarce. In this study, results of two telephone surveys are discussed. The surveys comprise interviews with more than 500 flood-affected households in Germany (Münster and Greven) and the Netherlands (Amsterdam), related to the severe rain event of July 28th 2014. Respondents were asked a series of questions about the damage to their building structure and contents, as well as on topics such as early warning, emergency and precautionary measures, building properties and hazard characteristics. The questionnaire was developed with the aim to create a harmonized transnational pluvial flood damage survey that can potentially be extended to other European countries. New indicator variables have been developed to account for different national and regional standards in building structure, early warning, socio-economic data and recovery. The survey data from the German and Dutch case studies are compared with the goal to identify similarities and differences in damage reducing factors and recovery. Water level data and other hazard characteristics are used to form comparable groups out of the German and Dutch sample. Within these groups, regional distinctions in building topology and use are expected to have the strongest impact on differences between reported damage amounts of the two case studies. The newly collected data will be used in

  3. A preliminary study to Assess Model Uncertainties in Fluid Flows

    SciTech Connect

    Marc Oliver Delchini; Jean C. Ragusa

    2009-09-01

    The goal of this study is to assess the impact of various flow models for a simplified primary coolant loop of a light water nuclear reactor. The various fluid flow models are based on the Euler equations with an additional friction term, gravity term, momentum source, and energy source. The geometric model is purposefully chosen simple and consists of a one-dimensional (1D) loop system in order to focus the study on the validity of various fluid flow approximations. The 1D loop system is represented by a rectangle; the fluid is heated up along one of the vertical legs and cooled down along the opposite leg. A pressurizer and a pump are included in the horizontal legs. The amount of energy transferred and removed from the system is equal in absolute value along the two vertical legs. The various fluid flow approximations are compressible vs. incompressible, and complete momentum equation vs. Darcy’s approximation. The ultimate goal is to compute the fluid flow models’ uncertainties and, if possible, to generate validity ranges for these models when applied to reactor analysis. We also limit this study to single phase flows with low-Mach numbers. As a result, sound waves carry a very small amount of energy in this particular case. A standard finite volume method is used for the spatial discretization of the system.

  4. A Preliminary Study of 3D Printing on Rock Mechanics

    NASA Astrophysics Data System (ADS)

    Jiang, Chao; Zhao, Gao-Feng

    2015-05-01

    3D printing is an innovative manufacturing technology that enables the printing of objects through the accumulation of successive layers. This study explores the potential application of this 3D printing technology for rock mechanics. Polylactic acid (PLA) was used as the printing material, and the specimens were constructed with a "3D Touch" printer that employs fused deposition modelling (FDM) technology. Unconfined compressive strength (UCS) tests and direct tensile strength (DTS) tests were performed to determine the Young's modulus ( E) and Poisson's ratio ( υ) for these specimens. The experimental results revealed that the PLA specimens exhibited elastic to brittle behaviour in the DTS tests and exhibited elastic to plastic behaviour in the UCS tests. The influence of structural changes in the mechanical response of the printed specimen was investigated; the results indicated that the mechanical response is highly influenced by the input structures, e.g., granular structure, and lattice structure. Unfortunately, our study has demonstrated that the FDM 3D printing with PLA is unsuitable for the direct simulation of rock. However, the ability for 3D printing on manufactured rock remains appealing for researchers of rock mechanics. Additional studies should focus on the development of an appropriate substitution for the printing material (brittle and stiff) and modification of the printing technology (to print 3D grains with arbitrary shapes).

  5. Preliminary study for pixel identification on a modular gamma camera

    NASA Astrophysics Data System (ADS)

    Soluri, A.; Atzeni, G.; Ucci, A.; Cusanno, F.; Massari, R.

    2014-02-01

    Our group has recently investigated and produced new scintigraphic prototypes based on advanced scintillation structure. The aim of this study is to demonstrate the use of scintillation matrices with size equal to the overall area of the Position Sensitive Photomultiplier Tube (PSPMT), to design a modular gamma camera and study the solution of the dead area problems optimizing the overall pixel identification. In this paper we investigate the response of different combinations with crystals integrated within tungsten structure, coupled with H8500, R8900-C12 and R11265-M64 Hamamatsu PSPMTs. Several scintillation matrices, whose dimensions match to the physical area of the PSPMT, have been analysed so that we have also studied limits of detection for the elements of the matrix in the critical zones of the PSPMT, i.e. corners and borders. In order to enhance the detectability of scintillation elements we improved the light collection by depositing metallic layers or treating the tungsten structure with different coating materials, and shaping the external elements of the scintillation matrices. The results have shown good energy resolution and the proposed method can be applied in medical imaging for obtaining high efficiency scintillation devices.

  6. Parkinson's disease and forced exercise: a preliminary study.

    PubMed

    Qutubuddin, Abu; Reis, Timothy; Alramadhani, Raed; Cifu, David X; Towne, Alan; Carne, William

    2013-01-01

    Objective. The concept of forced exercise has drawn attention for the treatment of Parkinson's disease symptoms with anecdotal reports of success. This study sought to ascertain any significant effect of forced exercise using a motorized stationary bicycle when compared to controls on Parkinson's disease symptoms in a blinded, randomized, and controlled setting. Setting. Parkinson's disease outpatient clinic, Veterans Administration Medical Center. Method. We assessed 23 patients (13 experimental and 10 controls) on a number of standard Parkinson's measures at baseline, after participation in eight weeks of twice weekly forced exercise or eight weeks of conventional clinic care, and then after a three-month period had elapsed. Dependent measures were UPDRS-III, Berg Balance Scale, finger taping test, and the PDQ-39. Results. Results did not demonstrate any main effect differences between the exercise and control groups on any measure at any point in time. A within subjects effect was demonstrated for the forced exercise group on overall UPDRS-III scores at the three-month end point. No other within group effects were noted. Results suggest that early enthusiasm for forced exercise may need tempering. Limitations of the study are discussed as well as numerous logistical challenges to this type of study.

  7. Preliminary studies on cryopreservation of snakehead (Channa striata) embryos.

    PubMed

    Mohd Sharifuddin, M; Siti Azizah, M N

    2014-08-01

    This paper reports the findings of the ongoing studies on cryopreservation of the snakehead, Channa striata embryos. The specific objective of this study was to collect data on the sensitivity of C. striata embryo hatching rate to low temperatures at two different developmental stages in the presence of four different cryoprotectants. Embryos at morula and heartbeat stages were selected and incubated in 1M dimethyl sulfoxide (Me2SO), 1M ethylene glycol (EG), 1M methanol (MeOH) and 0.1M sucrose solutions at different temperatures for a period of time. Embryos were kept at 24 °C (control), 15 °C, 4 °C and -2 °C for 5 min, 1h and 3h. Following these treatments, the embryos were then transferred into a 24 °C water bath until hatch to evaluate the hatching rate. The results showed that there was a significant decrease of hatching rate in both developmental stages following exposure to 4 °C and -2 °C at 1h and 3h exposure in each treatment. Heartbeat stage was more tolerant against chilling at -2 °C for 3h exposure in Me2SO followed by MeOH, sucrose and EG. Further studies will be conducted to find the best method to preserve embryos for long term storage.

  8. Preliminary studies on cryopreservation of snakehead (Channa striata) embryos.

    PubMed

    Mohd Sharifuddin, M; Siti Azizah, M N

    2014-08-01

    This paper reports the findings of the ongoing studies on cryopreservation of the snakehead, Channa striata embryos. The specific objective of this study was to collect data on the sensitivity of C. striata embryo hatching rate to low temperatures at two different developmental stages in the presence of four different cryoprotectants. Embryos at morula and heartbeat stages were selected and incubated in 1M dimethyl sulfoxide (Me2SO), 1M ethylene glycol (EG), 1M methanol (MeOH) and 0.1M sucrose solutions at different temperatures for a period of time. Embryos were kept at 24 °C (control), 15 °C, 4 °C and -2 °C for 5 min, 1h and 3h. Following these treatments, the embryos were then transferred into a 24 °C water bath until hatch to evaluate the hatching rate. The results showed that there was a significant decrease of hatching rate in both developmental stages following exposure to 4 °C and -2 °C at 1h and 3h exposure in each treatment. Heartbeat stage was more tolerant against chilling at -2 °C for 3h exposure in Me2SO followed by MeOH, sucrose and EG. Further studies will be conducted to find the best method to preserve embryos for long term storage. PMID:24726775

  9. A preliminary study of the associations among preterm infant behaviors.

    PubMed

    Liaw, Jen-Jiuan; Yuh, Yeong-Seng; Chang, Ling-Hua

    2005-03-01

    The purpose of this study was to examine whether relationships exist among various preterm infant behaviors. The study used an exploratory method design. Twenty infants were bathed and a total of 120 baths were video recorded and observed to measure preterm infant behaviors based on the frequency that behaviors occurred. The frequency was measured by using the preterm infant behavioral coding scheme developed for the study. Pearson Correlation Coefficients were used to analyze the behavioral data and examine whether the relationships among these behaviors were significant. The interrater reliability of the behavioral variables ranged from .82 to .99. There were highly positive correlations between the stress behaviors. There was, however, negative correlation between the stress behaviors and the stable behavior (sucking). The occurrences of the stress behaviors were associated with the state of " eyes open " and "fuss or crying". Knowing the associations may enhance NICU nurses ' abilities to identify preterm infant behaviors. While interacting with preterm infants, nurses can sensitively and actively sense preterm infant signals, prevent or ameliorate the early threats to an infant ' s life, and adjust care to support the infant ' s growth and development.

  10. Mesiodistal odontometrics as a distinguishing trait: A comparative preliminary study

    PubMed Central

    Sravya, Taneeru; Dumpala, Rakesh Kumar; Guttikonda, Venkateswara Rao; Manchikatla, Praveen Kumar; Narasimha, Vanajakshi China

    2016-01-01

    Introduction: Sex determination is a vital step in reconstructing an individual profile from unidentified skeletal remnants. Variations in tooth size are influenced by genetic and environmental factors. Tooth size variations have been reported among different populations. Aim: To identify the sex by determining the mesiodistal (MD) dimensions of maxillary canines. Objectives: (1) To compare the MD diameter of all maxillary canines — (a) in the entire urban and tribal population, (b) in urban male and urban female populations, (c) in tribal male and tribal female populations, and (d) in the entire male and female populations and (2) To estimate the percentage of sexual dimorphism individually in urban and tribal populations. Materials and Methods: Fifty subjects each from urban and tribal populations in equal gender ratio were selected in Khammam district, Telangana, for the purpose of this study. After obtaining informed consent, maxillary study models of the selected subjects were made. MD diameters of left and right maxillary canines were measured on casts using vernier calipers. The obtained data were subjected to statistical analysis. Results: (1) The total tribal population showed a greater MD diameter of maxillary canines than the total urban population, (2) Urban males showed a greater MD diameter of maxillary canines than urban females, (3) Tribal males showed a greater MD diameter of maxillary canines than tribal females, (4) The entire male population showed a greater MD diameter of maxillary canines than the entire female population, and (5) The percentage of dimorphism between males and females in individual groups was found to be significant. Conclusion: The study showed maxillary canines exhibiting significant sexual dimorphism and can be used as a distinguishing trait for sex determination along with other procedures. PMID:27555727

  11. Noninvasive mechanical body contouring: a preliminary clinical outcome study.

    PubMed

    Ersek, R A; Mann, G E; Salisbury, S; Salisbury, A V

    1997-01-01

    L.P.G.'s Endermologie is a massage method consisting of positive pressure rolling, in conjunction with applied negative pressure to both the, skin and subcutaneous tissues (L.P.G. Endermologie U.S.A., 3101 North Federal Highway, Suite 301 Fort Lauderdale, Florida 33306, U.S.A., (800) 222-3911). Devised in France during the 1970s, L.P.G.'s original purpose was to soften scars and standardize physical therapy; however, patients treated with the L.P.G. machine also showed an improvement in body contour and skin texture. Since then, several thousand machines have been in use in France as an alternative method for altering fat distribution in the subcutaneous plane. The authors began a study to determine the safety and efficacy of this machine. This study is composed of 22 women between the ages of 24 and 48. All 22 women completed at least seven sessions of treatments. Six of these 22 women completed all 14 sessions of the prescribed treatments. The study group exhibited a wide range of body habitus, initial weights, and final results. Of the 22 women who completed seven sessions of treatment, three had an increase in body weight and a mean index (see Materials and Methods) reduction in body diameter of 1.38 cm (0.5 in). Three of the six patients who completed all 14 treatment sessions had an increase in body weight and a mean index reduction in body diameter of 2.85 cm (1.12 in). All but one of the patients had a decrease in their mean body diameter index, regardless of their loss or gain in weight.

  12. A preliminary study of dengue infection in Brunei.

    PubMed

    Osman, Osmali; Fong, Mun Yik; Devi, Shamala

    2007-07-01

    The purpose of this study was to examine the extent of dengue infection in Brunei and to determine the predominant serotype circulating in the country. The study generated useful epidemiological data on dengue infection in Brunei. A total of 271 samples from patients suspected of having dengue infections were selected and analyzed. All patients were seen in clinics and hospitals in Brunei. The samples were collected from April 2005 to April 2006 and transported to the WHO Collaborating Centre for Arbovirus Reference and Research, University of Malaya, Malaysia. The following tests were used to achieve the objectives: in-house IgM-capture enzyme-linked immunosorbent assay, virus isolation in mosquito albopictus cell line (C6/36), and viral RNA detection and serotyping by reverse transcriptase-polymerase chain reaction (RT-PCR). The results show that 45 people were positive for dengue-specific IgM (27 males and 18 females), while RT-PCR detected dengue viral RNA in 12 patients, 3 identified as DEN-1 and 9 as DEN-2. Dengue virus was isolated from 6 patients using the C6/36 cell line; 3 were DEN-2 isolates and 3 were DEN-1 isolates. These data show that dengue virus is circulating in Brunei and the predominant infecting serotype for that period was DEN-2 followed by DEN-1. This study is the first to report the detection and isolation of dengue virus from Brunei using RT-PCR and culture in the C6/36 albopictus mosquito cell line.

  13. Magnetic field studies by Voyager 1 - Preliminary results at Saturn

    NASA Technical Reports Server (NTRS)

    Ness, N. F.; Acuna, M. H.; Lepping, R. P.; Connerney, J. E. P.; Behannon, K. W.; Burlaga, L. F.; Neubauer, F. M.

    1981-01-01

    Confirmation and refinement of Saturnian magnetosphere features established by the Pioneer 11 emission are claimed for Voyager 1 magnetic field studies of the planet. The radius of the magnetopause at the subsolar point is 23 Saturn radii, and a magnetic tail of 80 Saturn radii diameter was discovered. The tail extends away from the sun and is similar to both type II comet tails and the terrestrial and Jovian magnetic tails. Data from Voyager's very close flyby of Titan, which is located within the Saturn magnetosphere, shows an absence of any substantial, intrinsic satellite magnetic field.

  14. A preliminary phenomenological study of being hypnotized and hypnotizing.

    PubMed

    Woodard, Fredrick James

    2005-10-01

    This paper presents phenomenological research conducted following Woodard's phenomenological and perceptual research methodology for understanding hypnotic experiencing. The research emphasizes examining the internal experiencings of individuals involved in hypnotic experiencing. Examples are presented of Individual Situated Structures and the General Structures from both a group of 8 participants who hypnotized their clients and another group of 17 individuals who volunteered to be hypnotized. The explicated themes identified in hypnotic experiencing (the hypnotic relationship, phenomenology of trance, use of imagination, problem with psychic energy, a gestalt of experiencing, and linear-nonlinear experiencing) are discussed. The author discusses limitations of this study and suggestions for further work. PMID:16342574

  15. Preliminary study of digital image correlation based optical coherence elastography

    NASA Astrophysics Data System (ADS)

    Sun, Cuiru; Vuong, Barry; Wen, Xiao-Yan; Yang, Victor

    2013-06-01

    Optical coherence elastography (OCE) provides deformation or material properties mapping of soft tissue, which is important for morphological and pathological studies of the tissue. An OCE technique is developed based on digital image correlation. System calibration and measurement error evaluation are performed. The displacement measurement of 0.6 μm to over 100 μm was obtained through a phantom experiment. The capability of this OCE technique for differentiation of stiffness was evaluated by imaging a two-components phantom. OCE imaging of an aneurysm sample shows promising results for characterization of composites of aneurismal wall in the future.

  16. Radio frequency compatibility between IRS and SPOT 3: Preliminary study

    NASA Astrophysics Data System (ADS)

    Grondin, M.

    1986-01-01

    The RF compatibility between the Indian satellite IRS and SPOT 3 during launch and first orbits, with the hypothesis of a double launch on Ariane 4 was studied. Results are given in carrier-to-interference ratios for the TM and TC links. Concerning intersatellite compatibility, there can be a problem during the first orbit, when the intersatellite distance is only 2 m: the TC of each satellite is interfered with by the TM of the other satellite. Concerning satellites/Earth stations compatibility, there is no problem for the TM links and for the TC links.

  17. Magnetic field studies by Voyager 2 - Preliminary results at Saturn

    NASA Technical Reports Server (NTRS)

    Ness, N. F.; Acuna, M. H.; Behannon, K. W.; Burlaga, L. F.; Connerney, J. E. P.; Lepping, R. P.; Neubauer, F. M.

    1982-01-01

    Results of Voyager 2 studies of the magnetosphere and planetary magnetic field of Saturn are presented. Magnetometer studies have confirmed the results obtained by Voyager 1, indicating the magnetic field to be that of a centered dipole of moment 0.21 gauss Saturn radii-cubed, tilted approximately 0.8 deg from the rotation axis and a maximum measured field intensity of 1187 nT at latitude 17.3 deg N just before periapsis. Voyager 2 observed multiple bow shock and magnetopause crossings during its inbound and outbound trajectories, which were complementary to those of Voyager 1, including magnetopause crossing at 18.5 Saturn radii on the inbound trajectory, and at 48.4-50.9 Saturn radii outbound indicative of magnetospheric expansion due to changing solar wind conditions. Throughout the outbound passage, the magnetospheric field was observed to be relatively steady and smooth, with no evidence for any azimuthal asymmetry or magnetic anomaly. Results thus are incapable of accounting for the observed periodic modulation of the Saturnian kilometric radio emissions.

  18. Ultrasonic nebulization atmospheric pressure glow discharge - Preliminary study

    NASA Astrophysics Data System (ADS)

    Greda, Krzysztof; Jamroz, Piotr; Pohl, Pawel

    2016-07-01

    Atmospheric pressure glow microdischarge (μAPGD) generated between a small-sized He nozzle jet anode and a flowing liquid cathode was coupled with ultrasonic nebulization (USN) for analytical optical emission spectrometry (OES). The spatial distributions of the emitted spectra from the novel coupled USN-μAPGD system and the conventional μAPGD system were compared. In the μAPGD, the maxima of the intensity distribution profiles of the atomic emission lines Ca, Cd, In, K, Li, Mg, Mn, Na and Sr were observed in the near cathode region, whereas, in the case of the USN-μAPGD, they were shifted towards the anode. In the novel system, the intensities of the analytical lines of the studied metals were boosted from several to 35 times. As compared to the conventional μAPGD-OES with the introduction of analytes through the sputtering and/or the electrospray-like nebulization of the flowing liquid cathode solution, the proposed method with the USN introduction of analytes in the form of a dry aerosol provides improved detectability of the studied metals. The detection limits of metals achieved with the USN-μAPGD-OES method were in the range from 0.08 μg L- 1 for Li to 52 μg L- 1 for Mn.

  19. Preliminary study on hydrogeology in tectonically active areas.

    SciTech Connect

    Lowry, Thomas Stephen; Lappin, Allen R.; Gettemy, Glen L.; Jensen, Richard Pearson; Arnold, Bill Walter; James, Scott Carlton; Lee, Moo Yul; Meier, Diane A.

    2006-09-01

    This report represents the final product of a background literature review conducted for the Nuclear Waste Management Organization of Japan (NUMO) by Sandia National Laboratories, Albuquerque, New Mexico, USA. Internationally, research of hydrological and transport processes in the context of high level waste (HLW) repository performance, has been extensive. However, most of these studies have been conducted for sites that are within tectonically stable regions. Therefore, in support of NUMO's goal of selecting a site for a HLW repository, this literature review has been conducted to assess the applicability of the output from some of these studies to the geological environment in Japan. Specifically, this review consists of two main tasks. The first was to review the major documents of the main HLW repository programs around the world to identify the most important hydrologic and transport parameters and processes relevant in each of these programs. The review was to assess the relative importance of processes and measured parameters to site characterization by interpretation of existing sensitivity analyses and expert judgment in these documents. The second task was to convene a workshop to discuss the findings of Task 1 and to prioritize hydrologic and transport parameters in the context of the geology of Japan. This report details the results and conclusions of both of these Tasks.

  20. Preliminary studies on immobilization of lipase using chicken eggshell

    NASA Astrophysics Data System (ADS)

    Salleh, S.; Serri, N. A.; Hena, S.; Tajarudin, H. A.

    2016-06-01

    A few advantages of enzyme immobilization are reusability of expensive enzyme, improvement of stability and activity compared to crude enzyme. Various organic components can be used as carrier for enzyme immobilization such as chicken eggshell. It can be used as a carrier for immobilization as its mineral component mostly contains of calcium carbonate. In the present study, Tributyrin method was used to test enzyme activity of Rhizomucour Miehei, Candida Antarctica and Candida Rugosa. Rhizomucour Miehei shows the highest enzyme activity (360.8 mol/min/mL lipase) and was used in further experiment. Experiment was continued to study incubation time for lipase immobilization on eggshell (1-4 hours) and reaction time of esterification of sugar ester (0-72 hours). Two hours incubation time for lipase immobilization was observed and gives the highest yield of sugar ester (78.13%). Fructose and stearic acid as substrate was used for the production of sugar ester. The highest percentage of sugar ester production was shown at 36 hours of reaction time.