Jorge O. Galante

Bio: Jorge O. Galante is an academic researcher from Rush University Medical Center. The author has contributed to research in topics: Arthroplasty & Femur. The author has an hindex of 78, co-authored 220 publications receiving 21626 citations. Previous affiliations of Jorge O. Galante include University of Illinois at Chicago & Ohio State University.

An Analysis of Blood Management in Patients Having a Total Hip or Knee Arthroplasty

Abstract: Three hundred and thirty orthopaedic surgeons in the United States participated in a study of transfusion requirements associated with total joint arthroplasty. A total of 9482 patients (3920 patients who had a total hip replacement and 5562 patients who had a total knee replacement) were evaluated prospectively from September 1996 through June 1997. Of those patients, 4409 (46 percent [57 percent of the patients who had a hip replacement and 39 percent of the patients who had a knee replacement]) had a blood transfusion. Two thousand eight hundred and ninety patients (66 percent) received autologous blood, and 1519 patients (34 percent) received allogenic blood. Ordered logistic regression analysis showed the most important predictors of the transfusion of allogenic blood to be a low baseline hemoglobin level and a lack of predonated autologous blood. Preoperative donation of autologous blood decreases the risk of transfusion of allogenic blood; however, inefficiencies in the procedures for obtaining autologous blood were identified. Sixty-one percent (5741) of the patients had predonated blood for autologous transfusion, but 4464 (45 percent) of the 9920 units of the predonated autologous blood were not used. Primary procedures and revision total knee arthroplasty were associated with the greatest number of wasted autologous units. Of the 5741 patients who had predonated blood, 503 (9 percent) needed a transfusion of allogenic blood. The frequency of allogenic blood transfusion varied with respect to the type of operative procedure (revision total hip arthroplasty and bilateral total knee arthroplasty were associated with the highest prevalence of such transfusions) and with a baseline hemoglobin level of 130 grams per liter or less. Transfusion of allogenic blood was also associated with infection (p < or = 0.001), fluid overload (p < or = 0.001), and increased duration of hospitalization (p < or = 0.01). These latter findings warrant further evaluation in controlled studies.

A Study of Lower-Limb Mechanics During Stair-Climbing

Abstract: The motions, forces, and moments at the major joints of the lower limbs of ten men ascending and descending stairs were analyzed using an optoelectronic system, a force-plate, and electromyography. The mean values for the maximum sagittalplane motions of the hip, knee, and ankle were 42, 88, and 27 degrees, respectively. The mean maximum net flexion-extension moments were: at the hip, 123.9 newton-meters going up and 112.5 newton-meters going down stairs; at the knee, 57.1 newton-meters going up and 146.6 newton-meters going down stairs; and at the ankle, 137.2 newton-meters going up and 107.5 newton-meters going down stairs. When going up and down stairs large moments are present about weight-bearing joints, but descending movements produce the largest moments. The magnitudes of these moments are considerably higher than those produced during level walking.

The influence of total knee-replacement design on walking and stair-climbing.

Abstract: The relationship between gait and prosthetic design was studied during level walking and stair-climbing for twenty-six asymptomatic patients after total knee replacement. An age-matched group of fourteen control subjects was also studied. Five designs of total knee replacement Geomedic, Gunston, total condylar, duopatellar, and Cloutier were used. Differences in gait could be identified on the basis of prosthetic design. The more stressful stair-climbing test produced more clearly differentiated function among the different designs. Patients who were treated with the least-constrained cruciate-retaining (Cloutier) design of prosthesis were the only group that had a normal range of motion during climbing up and down stairs. Two groups of patients with semiconstrained (total condylar and Geomedic) designs had a lower than normal range of knee fiexion while descending stairs. Patients with the other designs of prosthesis had a normal range of knee motion on stair-climbing. Kinematic and anatomical differences among the five designs did not have as great an influence on function during level walking as they did during stair-climbing. The results of this study indicate that after total knee replacement even asymptomatic patients with excellent clinical results have an abnormality of gait. The features of the abnormality were common to most of the patients in the series, and consisted of a shorter than normal stride length, reduced mid-stance knee flexion, and abnormal patterns of external flexion-extension moment of the knee. Although an explanation of these abnormalities of gait is not completely possible at this time, they appear to be related to the interaction of the kinematics of the knee and surrounding soft tissues. CLINICAL RELEVANCE: It appears that patients with less constrained cruciate-retaining designs of total knee replacement have a more normal gait during stairclimbing than patients with more constrained cruciate-sacrificing designs. During level walking, patients with five quite different designs all had abnormalities of gait in spite of a successful clinical result. There is currently a great deal of controversy regarding which type of total knee prosthesis provides better Funded in part by National Institutes of Health Grants KO4AMO()493 and ROIAM2O7O2 and by the Arthritis Foundation. 1 Department of Orthopedic Surgery . Rush-Presbyterian-St. Luke’s N’lcdical Center. 753 Wcst Congress Parkway, Chicago. Illinois 60612. gait. An improved understanding of gait and the variables associated with total knee designs is essential in addressing this controversy. Quantitative studies of gait during activities of daily living are needed to generate this information, and will be useful for the evaluation of total kneereplacement devices and for providing understanding of the loading patterns that may occur during normal activity. Several studies have evaluated gait in patients with knee disease. These investigations included kinematic analyses I .6.7.9.I i.2I , time-distance measurements, and force-plate measurements. There have also been several kinetic and force-analysis studies of function in normal subjects and in patients after treatment for knee disabilitiesaIa14l7ao. The common finding of these studies was that patients who appear to be clinically asymptomatic after joint replacement have abnormal gait patterns. Currently, little is known about the nature of the gait abnormality in patients after total knee replacement or its relationship to total knee-replacement design. The purpose of this study was to evaluate the relationship between gait and total knee-replacement design. The prosthetic knees that were selected for this study were considered to be representative of cruciate-sacrificing and sparing designs with varying amounts of constraint. The parameters ofgait that we observed included time-distance patterns and motion and moments of the knee joint. The gait of patients who had received one of five different designs of total knee replacement was evaluated and cornpared with that of control subjects. Materials and Methods Twenty-six patients. in five experimental groups. were studied during level walking and stair-climbing. Patients were grouped according to which of five total knee designs they had received. The five implants selected for this study were the Geomedic, Gunston, total condylar. duopatellar, and Cloutier designs. The five designs of prosthesis were selected to represent varying shapes of the articular surfaces and the retention of one, both, or neither cruciate ligament. The Geomedic prosthesis has fairly congruous articular surfaces. requires removal of the anterior cruciate ligament, permits retention of the ps)sterior cruciate ligament. and does not include a patellar flange or resurfacing. The Gunston prosthesis consists of two separate semicircular runners that articulate with two independent tibial components, permits retention of both cruciate ligaments. and does not include patellar resurfacing or a patellar flange. The total condylar design requires the sacrifice of both cruciate ligaments. with anterior-posterior stability provided by the conformity of the tibial articulating surfaces; all patients with this design had patellar resurfacing. The duopatellar prosthesis permits retention of the posterior cruciate ligament. includes a patellar flange. and allows patellar resurfacing, which was performed in all of the patients whom we examined. The Cloutier prosthesis allows retention of both cruciate ligaments and the femoral condyles are asymmetneal, diverge. and have varying radii of curvature. The tibial component of the Cloutier device consists of flat articular surfaces supported on a metal retainer, and the design has a patellar flange. but patellar resurfacing was not performed in our patients. The patients selected for this study were matched according to postoperative pain. function, passive range of motion, and joint stability. A point system based on The Hospital for Special Surgery knee.rating system was used to quantitate

Wear patterns on retrieved polyethylene tibial inserts and their relationship to technical considerations during total knee arthroplasty.

Abstract: Fifty-five unconstrained polyethylene tibial inserts were retrieved at revision total knee arthroplasty and examined for evidence of wear after a mean implantation time of 34.2 months (2.5-80 months). Twenty inserts were ultra-high molecular weight polyethylene (UHMWPE) and 35 were carbon-reinforced polyethylene. Topographic maps of the articular and metal-backed surfaces of each component were constructed to characterize the extent and location of polyethylene degradation, identified visually by mode. In 32 of the retrieved inserts, pre- and postarthroplasty or prerevision radiographs were analyzed for component positioning, sizing, and extremity alignment. These factors then were compared with the patterns and severity of polyethylene wear on the inserts to establish correlations. Severe generalized articular wear was seen in inserts with third body wear from patellar metal-backed failure and cement debris. Severe localized delamination wear was seen in inserts with rotational-subluxation patterns of wear (p = 0.05). The external rotation subluxation wear pattern was strongly associated with knees that had lateral subluxation of the patella (p = 0.0002). Articular wear and cold flow into screw holes tended to be greater in the tightest prearthroplasty compartment (medial in the varus knee [p = 0.0157]; lateral in the valgus knees [p = 0.0226]). Fourteen of 16 knees with a preoperative varus deformities--even when corrected to a normal postarthroplasty anatomic axis--still had greater medial compartment articular wear (p = 0.001). Twelve of these knees did not have a medial release at the time of initial arthroplasty. Preoperative varus also was found to be related to the occurrence of posteromedial cold flow of polyethylene into tibial tray screw holes (p = 0.007). Increasing tibial insert posterior slope was associated with increasingly posterior articular wear track location (p = 0.03). This study indicates that unconstrained tibial component wear patterns and severity may be associated with clinical and mechanical factors under the surgeon's control, including component size and position, and knee alignment and ligament balance.