Showing papers in "Clinical Orthopaedics and Related Research in 1988"
TL;DR: A new periacetabular osteotomy of the pelvis has been used for the treatment of residual hip dysplasias in adolescents and adults and there was no evidence of vascular impairment of the osteotomized fragment.
Abstract: A new periacetabular osteotomy of the pelvis has been used for the treatment of residual hip dysplasias in adolescents and adults. The identification of the joint capsule is performed through a Smith-Petersen approach, which also permits all osteotomies to be performed about the acetabulum. This ost
1,154 citations
TL;DR: Increasing clinical evidence suggests that distal filling of the femur also is necessary to minimize the incidence of postoperative symptoms, particularly in revision procedures, so that stable fixation may be achieved regardless of variations in bone geometry.
Abstract: The shape of the femoral canal is variable, much more variable, in fact, than most contemporary designs of femoral components would suggest or can accommodate. In the face of this variability, line-to-line or surface-to-surface contact is not expected between cementless implants and much of the endosteal surface. It also is apparent that changes in implant design are still needed if the normal biomechanics of the hip joint are to be restored in each patient and if component fixation is to be optimized. Most cementless components aim to achieve proximal load transfer to the femoral canal. However, increasing clinical evidence suggests that distal filling of the femur also is necessary to minimize the incidence of postoperative symptoms, particularly in revision procedures. If this is indeed the case, more accommodating designs of femoral components are needed that will enable proximal and distal fitting at the femoral canal so that stable fixation may be achieved regardless of variations in bone geometry.
735 citations
Journal Article•
TL;DR: A new classification of sacral fractures evolved and provided a better understanding of the mechanisms responsible for the associated neurologic symptoms and preliminary observations suggest that surgical decompression permitted significantly better neurologic recovery than nonsurgical methods.
Abstract: Sacral fractures, often undiagnosed and untreated, frequently result in neurologic symptoms and deficits to the lower extremities and urinary, rectal, and sexual dysfunctions. These same neurologic problems often remain the major chronic sequelae after the more obvious pelvic trauma lesion has healed. Specific treatments aimed at neurologic problems are available and may allow the patient functional recovery. This is illustrated by anatomic observations on the sacrum in 39 cadavers showing the relationship among sacral nerve roots within their foramina. These observations were valuable for a retrospective study of 236 consecutive patients with sacral fractures in a series of 776 patients with pelvic injuries. A new classification of sacral fractures evolved from this study and provided a better understanding of the mechanisms responsible for the associated neurologic symptoms. The classification is based on the direction, location, and level of sacral fractures. Three different zones were identified as having characteristic clinical presentations: Zone I, the region of the ala, was occasionally associated with partial damage to the fifth lumbar root. Zone II, the region of the sacral foramina, is frequently associated with sciatica but rarely with bladder dysfunction. Zone III, the region of the central sacral canal, is frequently associated with saddle anesthesia and loss of sphincter function. Routine pelvic roentgenograms were almost useless in identifying the pathologic process in sacral injuries with neurologic symptoms. Ferguson views, tomograms, and particularly computed tomography scans were crucial for understanding these injuries. Cystometrography was most helpful in positively identifying fractures causing neurogenic bladders. Cystometrograms should be ordered routinely in Zone III injuries. Preliminary observations suggest that surgical decompression permitted significantly better neurologic recovery than nonsurgical methods.
715 citations
TL;DR: A new instrumentation for posterior spinal surgery consists of metallic rods carved with diamond-shaped asperities on which vertebral hooks or screws can be screwed in any position, level, or degree of rotation, which allows mobilization of the vertebrae located at the apex of the curve and obtains a three-dimensional correction.
Abstract: A new instrumentation for posterior spinal surgery consists of metallic rods carved with diamond-shaped asperities on which vertebral hooks or screws can be screwed in any position, level, or degree of rotation. The rods are interlocked by means of devices for transverse traction (DTTs), rectangular constructs with multiple vertebral grips, the stability of which allows suppression of any postoperative external support. Initially designed to treat scoliosis, this instrumentation design allows mobilization of the vertebrae located at the apex of the curve and obtains a three-dimensional correction. Correction of the areas of the most important structural deformation can also be obtained at the level of the end vertebrae, without any need to resort to an important distraction force. The technique varies according to the various types of curvatures. Approximately 250 patients were operated upon from 1983 to 1985. In idiopathic scoliotic curvatures, the mean percentage of correction was 66%. An important improvement of the associated sagittal deformations and of the apical derotation was observed in flexible curves. In paralytic curves, particularly with a pelvic obliquity, the percentage of correction of the frontal deformation is 77%. All of the spine patients were ambulatory in the first postoperative week, without any external support, and returned to their school or family activities. In 43 patients with follow-up periods longer than two years, there were no technical errors in 38. The final angular loss of correction was less than 2 degrees in the error-free group.
573 citations
TL;DR: The theoretic degree of stress shielding of the femoral shaft in bending was calculated for cases with complete canal filling and a radiographic appearance of bone ingrowth and there was a strong correlation between this theoretic factor and the observed bone resorption.
Abstract: The influence of stem size and extent of porous coating on femoral bone resorption was examined in 411 cases of primary cementless hip arthroplasty. Moore design, cobalt alloy femoral implants with powder-made sintered porous coating on either one-third, two-thirds, or the full implant length were compared radiographically two years after surgery. A semiquantitative method was adopted for assessing resorption that involved dividing the anteroposterior (AP) and lateral roentgenograms into a total of 16 discrete sites. The 16 sites were qualitatively examined for evidence of resorption by either thinning or darkening of bone relative to the time immediately following surgery. Based on the number of sites that demonstrated resorption, the bone loss was classified as either minor and not likely to cause problems (0 to 4 sites) or pronounced and of potentially harmful clinical consequence (5 or more sites). Pronounced resorption occurred in 18% of the 411 cases. The use of larger stems resulted in increased occurrence of marked bone resorption: stems greater than or equal to 13.5 mm in diameter showed five times the incidence of pronounced resorption compared with stems less than or equal to 12.0 mm in diameter. Stems with two-thirds and full porous coating resulted in a twofold to fourfold increase in the incidence of pronounced bone resorption. The theoretic degree of stress shielding of the femoral shaft in bending was calculated for cases with complete canal filling and a radiographic appearance of bone ingrowth. There was a strong correlation between this theoretic factor and the observed bone resorption.
566 citations
TL;DR: In a series of 200 Charnley low friction arthroplasties revised for various reasons, the preoperative anteroposterior roentgenograms were categorized in terms of demarcation at the bone-cement interface of the socket and compared with the operative findings of movement at theBone-cements junction.
Abstract: In a series of 200 Charnley low friction arthroplasties revised for various reasons, the preoperative anteroposterior roentgenograms were categorized in terms of demarcation at the bone-cement interface of the socket and compared with the operative findings of movement at the bone-cement junction. All sockets showing no demarcation were found to be fixed soundly. Seven percent of the sockets showing demarcation of the outer one-third only were loose, and when two-thirds of the sockets were demarcated, 71% were loose. Ninety-four percent of the sockets with complete demarcation and all sockets that had migrated were found to be loose at revision. There is a definite correlation between roentgenographic demarcation and socket loosening. The more extensive the demarcation, the more likely it is that the socket is loose. Radiographic demarcation of the cemented socket is a prognostic sign for eventual failure.
529 citations
TL;DR: Transfer of the latissimus dorsi tendon from the humeral shaft to the superolateral humeral head provides a large, vascularized tendon that can be used to close a massive cuff defect and that exerts an external rotation and head-depressing moment that allow more effective action of the deltoid muscle.
Abstract: Symptomatic irrepairable rotator cuff tears usually entail complete loss of the substance of the supraspinatus and infraspinatus tendons. Loss of external rotation control and cranial migration of the humeral head on attempted flexion or abduction of the shoulder are the functional hallmarks. Transfer of the latissimus dorsi tendon from the humeral shaft to the superolateral humeral head provides a large, vascularized tendon that can be used to close a massive cuff defect and that exerts an external rotation and head-depressing moment that allow more effective action of the deltoid muscle. This procedure was carried out in 14 patients without any significant complications. Pain relief and functional results in those four cases with a minimum follow-up period of one year (average, 14 months) compared favorably with alternative treatment methods and warrant further anatomic, electromyographic, and clinical investigation.
427 citations
TL;DR: To investigate the histophysiology of implant degradation, hydroxyapatite and tricalcium phosphate cylinders with a diameter of 3 mm were implanted in the cancellous bone of the distal femur and the proximal tibia of 15 New Zealand White rabbits for up to six months and acid phosphatase-positive osteoclast-like cells suggesting active resorption adhere directly to the surface.
Abstract: To investigate the histophysiology of implant degradation, hydroxyapatite and tricalcium phosphate cylinders with a diameter of 3 mm were implanted in the cancellous bone of the distal femur and the proximal tibia of 15 New Zealand White rabbits for up to six months. All implants had a homogeneous pore distribution and a porosity of 60%. Ceramics with a pore size range of 50-100 micron and 200-400 micron were compared. Morphometric analysis showed that up to 85.4% of the originally implanted tricalcium phosphate was degraded after six months, whereas the volume reduction of the hydroxyapatite was only 5.4% after the same period. Within the first months bone and tissue ingrowth and implant resorption occurred at a higher rate in the smaller-pored tricalcium phosphate than in the larger-pored material. Hydroxyapatite cylinders with small pores were totally infiltrated by bone or bone marrow after four months, whereas in the larger-pored hydroxyapatite implants tissue did not penetrate all pores after six months and the amount of bone within the implant was small. Scanning electron microscopy of the material before implantation revealed the existence of numerous pore interconnections with diameters of about 20 micron in the smaller-pored ceramics. Such interconnections were rare in the larger-pored implants. The pore interconnections seem to promote vascular and tissue ingrowth and consequently the initial rate of implant resorption. Implant resorption is an active process and involves two different cell types. Acid phosphatase-positive osteoclast-like cells suggesting active resorption adhere directly to the surface, especially in tricalcium phosphate implants. Clusters of macrophages tightly packed with granular material are found in the pores and along the perimeter of all implant cylinders. They may play an active role in the intracellular degradation of small detached ceramic particles.
420 citations
Journal Article•
TL;DR: The major mechanisms of failure in total knee arthroplasty are loosening, instability, sepsis, extensor mechanism power loss, poor range of motion, bone fractures, and prosthesis fracture.
Abstract: The major mechanisms of failure in total knee arthroplasty are loosening, instability, sepsis, extensor mechanism power loss, poor range of motion, bone fractures, and prosthesis fracture. These are, for the most part, within the surgeon's control. Prosthetic alignment is the most important factor influencing postoperative loosening and instability.
413 citations
TL;DR: The newest knowledge on the osteoclast allows us to consider bone resorption in a global perspective, as the resultant of three successive steps that may each be individually regulated by physiopathologic or pharmacologic agents.
Abstract: The newest knowledge on the osteoclast allows us to consider bone resorption in a global perspective, as the resultant of three successive steps that may each be individually regulated by physiopathologic or pharmacologic agents. The first involves the formation of osteoclast progenitors in hematopoietic tissues followed by their vascular dissemination and the generation of resting preosteoclasts and osteoclasts in bone. The second consists in the activation of osteoclasts at the contact of mineralized bone. Osteoblasts appear to control this step by exposing the mineral to osteoclasts and preosteoclasts and/or by releasing a soluble factor that activates these cells. In a third step, activated osteoclasts resorb both the mineral and the organic of mineralized bone through the action of agents that they secrete in the segregated zone underlying their ruffled border. The mineral appears to be solubilized by hydrogen ions secreted by an ATP-driven proton pump located at that border and fed by protons generated from CO2 by carbonic anhydrase. The removal of organic matrix, which could be prepared by osteoblast collagenase at the level of nonmineralized bone surfaces, appears dependent on acid proteinases, particularly cysteine-proteinases, secreted, together with other lysosomal enzymes, in the acid microenvironment of the resorption zone.
370 citations
TL;DR: Measurements of the HA coating material showed no evidence of significant HA resorption in vivo after periods of up to 32 weeks, and there was a slight decrease in mean shear strength from the maximum value to that obtained after the longest implantation period (32 weeks).
Abstract: The interface mechanical characteristics and histology of commercially pure (CP) titanium- and hydroxyapatite- (HA) coated Ti-6Al-4V alloy were investigated. Interface shear strength was determined using a transcortical push-out model in dogs after periods of three, five, six, ten, and 32 weeks. Undecalcified histologic techniques with implants in situ were used to interpret differences in mechanical response. The HA-coated titanium alloy implants developed five to seven times the mean interface strength of the uncoated, beadblasted CP titanium implants. The mean values for interface shear strength increased up to 7.27 megaPascals (MPa) for the HA-coated implants after ten weeks of implantation, and the maximum mean value of interface shear strength for the uncoated CP titanium implants was 1.54 MPa. For both implant types there was a slight decrease in mean shear strength from the maximum value to that obtained after the longest implantation period (32 weeks). Histologic evaluations in all cases revealed mineralization of interface bone directly onto the HA-coated implant surface, with no fibrous tissue layer interposed between the bone and HA visible at the light microscopic level. The uncoated titanium implants had projections of bone to the implant surface with apparent direct bone-implant apposition observed in some locations. Measurements of the HA coating material made from histologic sections showed no evidence of significant HA resorption in vivo after periods of up to 32 weeks.
TL;DR: The authors summarize the current understanding of the structure and function of osteocalcin in bone and evaluate the clinical studies done using serum osteoccin and urinary Gla to monitor bone turnover.
Abstract: The vitamin K-dependent protein of bone, osteocalcin (bone Gla protein) is a specific product of the osteoblast. A small fraction of that synthesized does not accumulate in bone but is secreted directly into the circulation. Upon catabolism of osteocalcin, its characteristic amino acid, gamma-carboxyglutamic acid (Gla), is excreted into the urine. Both serum osteocalcin and urine Gla are currently being used for the clinical assessment of bone disease. The authors summarize the current understanding of the structure and function of osteocalcin in bone and evaluate the clinical studies done using serum osteocalcin and urinary Gla to monitor bone turnover. Factors that affect the measurement of osteocalcin concentrations in the blood are osteoblastic synthesis, content of Gla in the protein, drug-induced alterations in osteocalcin's affinity for bone, hormonal status, renal function, age, sex, timing of blood collection, and specificity of the radioimmunoassay. With these considerations, serum osteocalcin measurements provide a noninvasive specific marker of bone metabolism.
TL;DR: The major mechanisms of failure in total knee arthroplasty are loosening, instability, sepsis, extensor mechanism power loss, poor range of motion, bone fractures, and prosthesis fracture.
Abstract: The major mechanisms of failure in total knee arthroplasty are loosening, instability, sepsis, extensor mechanism power loss, poor range of motion, bone fractures, and prosthesis fracture. These are, for the most part, within the surgeon's control. Prosthetic alignment is the most important factor influencing postoperative loosening and instability.
TL;DR: Thirty-one closed fractures of the lower extremity in diabetics were retrospectively reviewed to determine healing times and there was a prolonged union time overall and in both insulin and oral hypoglycemic-controlled diabetICS.
Abstract: Thirty-one closed fractures of the lower extremity in diabetics were retrospectively reviewed to determine healing times There was a prolonged union time overall (163% of expected) and in both insulin and oral hypoglycemic-controlled diabetics (157% and 176% of expected) Displaced fractures showed a prolonged union time, while nondisplaced fractures healed in the normal time period (187% and 96% of expected) Fractures treated by open reduction had a more prolonged healing time than those treated by closed reduction (186% and 142% of expected), but this was primarily related to displacement Sex and age had no effect on union time The known effects of diabetes mellitus on bone and mineral metabolism in both experimental animals and humans may explain these prolonged union times
TL;DR: Mortality and cost calculations indicate that chemoprophylaxis is justified for dental procedures and probably also for other surgical procedures in organs containing microflora, and prophylaxis must include antistaphylococcal drugs.
Abstract: The incidence of late infection of total joint prostheses is 0.6%. Because this incidence has increased from 0.08% in 1978, the authors reviewed their experience and the literature in search of pathogenetic and preventative measures. The most common pathogen responsible for late prosthetic joint infections was staphylococcus (54%; both Staphylococcus aureus and Staphylococcus epidermidis), even when infection was of dental origin. The three most common origins of infection were skin and soft tissue (46%), dental (15%), and urinary (13%). Escherichia coli was the most common pathogen when the source was the urinary tract. Mortality and cost calculations indicate that chemoprophylaxis is justified for dental procedures and probably also for other surgical procedures in organs containing microflora. Prophylaxis must include antistaphylococcal drugs. The first generation cephalosporin antibiotics are recommended.
TL;DR: Not surprisingly, success in achieving and maintaining stable implant fixation following revision THA is dependent upon component design, surgical technique, and preexistent bone stock damage.
Abstract: The goals of revision total hip arthroplasty (THA) are to reestablish and maintain stable implant fixation Based upon promising early results in primary THA, porous-surfaced implants designed for bone ingrowth fixation are being increasingly used in hopes of more successfully achieving these goals than has been the case using cement One hundred and sixty such revisions were followed for a mean of 44 years, with specific reference to implant fixation Roentgenographic evaluation of implant fixation suggested four categories of femoral and acetabular components: (1) bone ingrown, (2) stable fibrous encapsulation, (3) questionable, with signs of impending instability, or (4) definitely unstable implant migration, indicative of the need for rerevision Not surprisingly, success in achieving and maintaining stable implant fixation following revision THA is dependent upon component design, surgical technique, and preexistent bone stock damage This classification according to bone stock damage should be borne in mind when critically evaluating the results from various revision series
TL;DR: Patellofemoral complications continue to form a large proportion (up to 50%) of total knee arthroplasty (TKA) complications if adequate attention is paid intraoperatively to patellar tracking and component position, the incidence of subluxation, component loosening, and fracture should decrease.
Abstract: Patellofemoral complications continue to form a large proportion (up to 50%) of total knee arthroplasty (TKA) complications. If adequate attention is paid intraoperatively to patellar tracking and component position, the incidence of subluxation, component loosening, and fracture should decrease. When treating patellar subluxation and dislocation, tibial tubercle transfer should be avoided because there is an unacceptably high incidence of complications. Care should be taken to treat the underlying cause of dislocation with either a soft tissue procedure or component revision. Fracture of the patella may be treated nonoperatively in 50% and 80% of patients. Cysts, if large, may be bone-grafted to avoid the potential complications of stress fracture and component loosening. Loosening of the patellar component is likely to be symptomatic and to require surgery in up to 75% of cases. A displaced patellar component may cause attritional wear of the quadriceps tendon or patellar ligament. All rheumatoid patellae should be resurfaced. The present trend in the osteoarthritic patella is toward resurfacing more often. With improved implant design and a predicted decrease in complications, resurfacing in the osteoarthritic patella may become routine. Osteoarthritic patellae that maintain good cartilage, normal anatomic shape, and congruent tracking need not be resurfaced.
TL;DR: The geometric prosthesis has provided a functional result in 69% of knees at 10 years, despite being the first two-part component knee replacement retaining the cruciate ligaments and using early surgical instrumentation and implant design.
Abstract: One hundred ninety-three geometric total knee arthroplasties (TKA) were performed between 1972 and 1975 in 129 patients (66 women, 63 men; mean age, 69 years) with osteoarthritis. Of these, 102 knees were followed for a mean of 11 years. Eighty-three percent of the patients had mild or no pain. The
TL;DR: Long-term follow-up studies using logistical regression analysis demonstrate significantly higher rates of femoral loosening with acetabular components placed in a superior and lateral (i.e., nonanatomic) position, compared with acetABular componentsplaced in a nearly anatomic position.
Abstract: Loosening is the most common long-term problem following total hip arthroplasty. Many factors, including patient selection, cement technique, femoral component placement, and prosthesis design reportedly affect the incidence of loosening. Theoretically, the location of the hip center of rotation substantially affects the load on the hip, and superior and lateral hip center location will result in higher loads than medial and inferior placement. Long-term follow-up studies (average, 9.1 years after surgery) using logistical regression analysis demonstrate significantly higher rates of femoral loosening with acetabular components placed in a superior and lateral (i.e., nonanatomic) position, compared with acetabular components placed in a nearly anatomic position.
TL;DR: With these methods, it is possible to obtain good elbow flexion in more than one-half of patients; however, only limited shoulder function and no useful finger function are obtained.
Abstract: In neurotization or nerve transfer, a healthy but less valuable nerve or its proximal stump is transferred in order to reinnervate a more important sensory or motor territory that has lost its innervation through irreparable damage to its nerve. In brachial plexus injuries, extraplexal nerves such as the spinal accessory nerve, rami of the cervical plexus, or intercostal nerves are transferred onto trunks, cords, or individual nerves or else segments of the brachial plexus that maintain continuity with the spinal cord may be coapted to trunks or cords the surgeon wishes to innervate. This method is particularly indicated in root avulsion injuries that occur frequently following traction trauma to the brachial plexus. The authors convey their experience with neurotization using the long thoracic nerve in seven cases, the accessory nerve in 30 cases, intercostal nerves in 66 cases, and various nerve transfers within the plexus in 31 cases. Results of other authors are also reported. With these methods, it is possible to obtain good elbow flexion in more than one-half of patients; however, only limited shoulder function and no useful finger function are obtained.
TL;DR: As the long-term survival of spinal cord injured patients continues to improve, an increased awareness of the complications of the weight-bearing upper extremity is necessary to keep these patients functioning in society.
Abstract: Paraplegic patients rely almost exclusively on their upper extremities for weight-bearing activities such as transfers and wheelchair propulsion. Eighty-four paraplegic patients whose injury level was T2 or below and who were at least one year from spinal cord injury were screened for upper extremity complaints. Fifty-seven (67.8%) had complaints of pain in one or more areas of their upper extremities. The most common complaints were shoulder pain and/or pain relating to carpal tunnel syndrome. Twenty-five (30%) complained of shoulder pain during transfer activities. Symptoms were found to increase with time from injury. As the long-term survival of spinal cord injured patients continues to improve, an increased awareness of the complications of the weight-bearing upper extremity is necessary to keep these patients functioning in society.
TL;DR: The authors have found that the Kocher-Langenbeck, ilioinguinal, and extended iliofemoral approaches are the most useful for displaced acetabular fractures.
Abstract: Displaced acetabular fractures occur primarily in young adults involved in high energy trauma and can lead to disabling posttraumatic arthritis An initial roentgenographic evaluation with accurate delineation of all fracture lines provides the key to decisions about whether to give closed or open treatment When open treatment is indicated, a surgical approach can be chosen that will almost always lead to reduction without the necessity of a second approach The authors have found that the Kocher-Langenbeck, ilioinguinal, and extended iliofemoral approaches are the most useful A fracture table and specialized reduction instruments aid fracture reduction and fixation Satisfactory operative reduction of the fracture is the factor that correlates best with a satisfactory clinical result The rate of satisfactory operative reductions improved gradually over the first 50 operations of a prospective study of 121 displaced acetabular fractures Overall, there were 80% satisfactory clinical results in this series Complications included a 3% infection rate and a 5% incidence of nerve palsy Open reduction and internal fixation are indicated for the majority of displaced fractures However, closed treatment can produce satisfactory results in selected patients
TL;DR: Variables such as the patient's age, sex, diagnosis, alignment and position of the prosthesis, and level of bone cut did not correlate with the development of radiolucencies at the cement-bone interface.
Abstract: This study deals with survivorship of total condylar knee arthroplasties in 87 consecutive patients (112 knees) with follow-up periods of up to 11 years. The end point of the survivorship was defined as: (1) the need for revision due to septic or aseptic loosening; (2) roentgenographic loosening evidenced by a shift of component position; or (3) radiolucency extending under the condyle of the tibial component and partially along the peg, when associated with clinical symptoms. Life table calculations predict 88.7% survivorship of total condylar knee arthroplasty. Using revision for septic or aseptic loosening and recommendation for surgery as an end point, the survivorship was 94.1% 11 years after operation in this series. Seventy-two patients (90 knees) of 87 were available for clinical and roentgenographic study at eight to 11 years. Eight patients (12 knees) had died and seven patients (ten knees) were lost to follow-up study. The results were excellent to good in 93%, fair in 3%, and poor in 4%. Roentgenographic evaluation revealed well-fixed components in 36 knees (40%). Radiolucencies of varying degrees were present in 54 knees (60%). Of the 54 knees, seven had radiolucency under the tibial condyle in Zones I-IV and partially along the peg in Zones V and VI. Two knees had component loosening, one with a loose patella and the other a loose tibial component; both of these patients were symptomatic. Variables such as the patient's age, sex, diagnosis, alignment and position of the prosthesis, and level of bone cut did not correlate with the development of radiolucencies at the cement-bone interface.(ABSTRACT TRUNCATED AT 250 WORDS)
TL;DR: Fifty-seven hips (55 patients) had revision for failed cemented femoral component loosening using titanium ingrowth femoral components and cancellous bone grafting, and all parameters of hip function improved with time.
Abstract: Fifty-seven hips (55 patients) had revision for failed cemented femoral component loosening using titanium ingrowth femoral components and cancellous bone grafting The patients' average age was 59 years (range, 25-86 years), and the average follow-up period was 28 years (range, two to six years) The preoperative hip score averaged 455 (range, 100-807) and the postoperative hip score averaged 825 (range, 430-1000) Complications included dislocation (40%), infection (40%, one recurrence from a previously infected hip and one acute hematogenous infection), and a 40% revision rate for loose femoral component Another patient had a revision for a loose acetabular component All parameters of hip function (ie, pain, limp, activities of daily living, use of support, and distance walked) improved with time Femoral component loosening is classified into four types based on the severity of loosening and instability In Type I there is minimal endosteal or inner cortical bone loss, ie, loosening from the cement-metal-bone interface or a broken stem (seven hips) In Type II there is proximal canal enlargement with cortical thinning of 50% or more and sometimes a lateral wall defect with an intact circumferential wall (23 hips) In Type III there is a posteromedial wall defect involving the lesser trochanter (23 hips) In Type IV there is total proximal circumferential bone loss in varying distances below the lesser trochanter (three hips) The Harris hip scores for the four groups were 930, 830, 800, and 780, respectively
TL;DR: Posterior lumbar interbody fusion is now used in conjunction with newly developed segmental spine plates by using transpedicular screw fixation to enhance the osteosynthesis and success rate of inter body fusion.
Abstract: Posterior lumbar interbody fusion (PLIF) is accepted by many authors as the surgical treatment for herniated discs, degenerative disc conditions, and Grades I and II spondylolistheses. PLIF is now used in conjunction with newly developed segmental spine plates by using transpedicular screw fixation to enhance the osteosynthesis and success rate of interbody fusion. To date, 104 fusions have been performed in 67 patients with no dislocations of any interbody grafts and no indication of absorption, pseudoarthrosis, or infections.
TL;DR: Results indicate that collagen is effective as a carrier of BMP for expression of the biologic activity of the latter in vivo and that it may be of practical use as a carriers of B MP with synthetic biomaterials.
Abstract: Porous hydroxyapatite (HA-P) discs (5 mm in diameter; 1.5 mm thick; porosity, 80%; mean pore size, 200 μm) were impregnated with purified bovine skin collagen (1 mg/disc) and a small amount of semipurified bone morphogenetic protein (BMP) of sarcoma origin (100μg/disc) and implanted into dorsal musc
TL;DR: In clinical terms, the cruciate-sacrificed TKA is less efficient and has greater medial loading and higher joint reaction forces that may affect durability of the prosthesis.
Abstract: Gait of 11 patients with bilateral paired posterior cruciate-retaining and cruciate-sacrificing total knee arthroplasties (TKA) was studied preoperatively and two years postoperatively on walking and stair climbing. Five-year clinical and roentgenographic examinations were included in the study. Differences between the two prostheses were noted both in level walking and in stair climbing. On level walking, cruciate-sacrificed TKA had more flexion in loading response and increased flexion and varus moments with increased muscle activity of quadriceps and biceps femoris. Abnormal gaits common to both types of knee were decreased flexion in stance and decreased single-limb stance. Both knees had a stiff-legged gait during stance. On stairs, the cruciate-sacrificed TKA substituted soleus muscle activity for knee stability. The single-limb stance and range of motion were similar for both knees. In clinical terms, the cruciate-sacrificed TKA is less efficient and has greater medial loading and higher joint reaction forces that may affect durability of the prosthesis. The five-year knee scores, patient satisfaction, and roentgenographic examinations were equal for both sets of knees.
TL;DR: The consistent association with excessive alcohol intake was confirmed and the immediate untoward effects of smoking was suggested and the role of heavy physical work as a form of mechanical stress was not correlated with ON.
Abstract: An epidemiologic study compared 112 patients with idiopathic osteonecrosis (ON) of the femoral head having no history of systemic corticosteroid use and 168 hospital controls. Patients and controls were matched for gender, age, ethnicity, hospital, and time of initial diagnosis. The role of alcohol intake, cigarette smoking, and occupational status was assessed in relation to the development of ON. The relative risk (RR), the measure of association between ON and the risk factors, was statistically adjusted for the potential confounding effects of other factors by the conditional logistic regression model. An elevated risk for regular drinkers (RR = 7.8, p less than 0.001) and a clear dose-response relationship was noted (test for trend; p less than 0.001): the RRs were 3.3, 9.8, and 17.9 for current consumers of less than 400, 400-1000, and greater than or equal to 1000 ml/week of alcohol, respectively. A significantly increased risk was found for current smokers (RR = 3.9; p less than 0.05). However, the cumulative effect of smoking was not evident. No increased risk was found for obesity or for heavy physical work. Regarding causation of ON, this study confirmed the consistent association with excessive alcohol intake and suggested the immediate untoward effects of smoking. The role of heavy physical work as a form of mechanical stress was not correlated with ON.
TL;DR: The records of 58 patients who had hallux rigidus and were treated with cheilectomy between 1977 and 1984 showed the following results: 53.4% completely satisfactory, 19% mostly satisfactory, 27.6% unsatisfactory.
Abstract: The records of 58 patients who had hallux rigidus and were treated with cheilectomy between 1977 and 1984 showed the following results: 53.4% completely satisfactory, 19% mostly satisfactory, 27.6% unsatisfactory. No deterioration of results with time was apparent. When the results were analyzed in