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Biomedical subjects

A E Gross

Publications and source records attributed to A E Gross.

At least 19 recordsLinked to original sources
PubMed1999

The use of structural allografts for treating periprosthetic fractures about the hip and knee.

When a periprosthetic fracture about the knee or hip is associated with segmental bone loss and a loose implant, a structural allograft may be indicated. The implant is cemented into the allograft but not into the host. The host graft junction is stabilized by the long stem of the implant and a step-cut osteotomy. The junction can be further reinforced by cortical strut allograft and residual host bone with soft tissues still attached to enhance union. Once the host bone unites to the allograft, the reconstruction is stabilized.

Aged↗
PubMed1999

Economic evaluations in the hip arthroplasty literature: lessons to be learned.

Readers are increasingly encountering articles dealing with health economic evaluations that compare various surgical strategies, leaving orthopaedists with the challenge of determining which program is cost-efficient and truly pertains to their setting. This study carries out a systematic review of the literature to appraise the quality, quantity, and type of economic evaluation as it pertains to the hip arthroplasty literature. To identify all relevant articles, we conducted a comprehensive computerized bibliographic search of Medline from 1966 to 1996. This search produced 1,611 abstracts that were screened. Studies that were incorporated met the following inclusion criteria: i) formal economic analysis, ii) an intervention specific to hip arthroplasty, and iii) the perspective of the study was evident (ie, patient, provider, society). These studies were appraised with regards to methodologic soundness based on 8 established economic principles. Only 68 articles from the 138 retrieved met the study criteria. Only 2 of the 68 articles met all 8 criteria of a comprehensive economic evaluation. The hip arthroplasty literature is deficient in methodologically sound economic evaluations. Several guidelines are introduced to aid orthopaedists in appraising the various economic studies, and recommendations are made to improve the quality of these studies in the orthopaedic literature. We suggest that the generation of such information should rank high on the priority list of the orthopaedic profession, granting agencies, and governments.

Arthroplasty, Replacement, Hip↗
PubMed1999

Evaluation of the allograft-prosthesis composite technique for proximal femoral reconstruction after resection of a primary bone tumour.

OBJECTIVE: To evaluate clinical and functional outcomes resulting from the allograft-composite technique used for proximal femoral osteoarticular reconstruction in patients who had limb salvage surgery for primary bone tumours. DESIGN: A retrospective review of a prospectively gathered database to provide a descriptive study. SETTING: A tertiary care musculoskeletal oncology unit in a university hospital. PATIENTS AND INTERVENTIONS: Patients treated between 1987 and 1993 were eligible for inclusion in this study if they met the following criteria: they were treated surgically for a primary malignant bone tumour; and a proximal femoral allograft-implant composite technique was used for the reconstruction. MAIN OUTCOME MEASURES: Major postoperative complications with emphasis on mechanical complications in the reconstructive composite implant. Functional outcome in a subset of patients using the 1987 and 1994 versions of the Musculoskeletal Tumor Society instrument, the Short-Form-36 and the Toronto Extremity Salvage Score. RESULTS: There were 5 mechanical and 2 infectious complications requiring surgical intervention. Functional scores were generally low. CONCLUSIONS: Our results suggest that the perceived benefits of the composite technique may accrue only to a few patients, partly owing to the risk of mechanical complications. Although these can be reduced by avoiding the use of cement in the host femur, the generally poor functional outcomes suggest that this technique needs to be studied further in this group of patients and compared with other reconstructive techniques, particularly the prosthetic implant.

Adult↗
PubMed1998

Proximal femoral allografts for reconstruction of bone stock in revision arthroplasty of the hip.

Full circumferential bone loss of the proximal femur can be managed by segmental allografts. The use of these grafts is indicated for uncontained defects longer than five cm in length. The femoral implant is cemented into the allograft but not into the host. The allograft host junction is stabilized by a step cut or oblique osteotomy and autografted with residual host femur. The results at five and nine years support this kind of reconstruction as a good alternative for this difficult problem.

Arthroplasty, Replacement, Hip↗
PubMed1998

The treatment of isolated articular cartilage lesions in the young individual.

The treatment of isolated articular cartilage defects is an evolving field in orthopaedic surgery today. We have summarized the basic science and clinical date on the treatment of isolated articular cartilage defects. Further long-term controlled studies are required in order to compare definitively the efficacy of treatments in this difficult clinical area. In future studies, inclusion/exclusion criteria must be detailed, and classification systems need to be standardized Comparative analysis can then be performed to assess the efficacy of various techniques.

Adolescent↗
PubMed1997

Immediate surgery versus waiting list policy in revision total hip arthroplasty. An economic evaluation.

An economic evaluation was carried out using a decision tree that models the costs and consequences of surgery at the point of consultation versus a waiting list policy for candidates in need of revision hip arthroplasty. The theoretical scenarios looked at a 2-year period wherein the immediate surgery patients incurred costs for 2 years after surgery, whereas the waiting list patients incurred costs for 1 year before and 1 year after surgery. Outcome probabilities were defined and applied to each treatment group, as derived from the literature and expert opinion. Expenditures were derived from the literature, based on conservative estimates of predicted pre- and postsurgical behavior for each scenario. This analysis indicates the potential for both substantial savings in resources and improved patient outcome for immediate surgery over waiting lists. These savings would begin at the inception of the immediate surgery protocol. Sensitivity analysis indicates that the conclusion is valid over a wide range of expenditures and probabilities.

Cost Savings↗
PubMed1997

The flying buttress acetabular bone-graft.

Primary total hip arthroplasty is often required in the end-stage osteoarthritic hip secondary to hip dysplasia. At the time of surgery, a decision is made whether to bone-graft the dysplastic acetabulum to accommodate the acetabular component. A technique is described to augment the acetabular bone stock by adding a flying buttress autograft to the structural shelf graft.

Acetabulum↗
PubMed1997

Fresh osteochondral allografts for post-traumatic osteochondral defects of the knee.

We used fresh small-fragment osteochondral allografts to reconstruct post-traumatic osteochondral defects in 126 knees of 123 patients with a mean age of 35 years. At a mean follow-up of 7.5 years (2 to 20), 108 knees were rated as successful (85%) and 18 had failed (15%). The factors related to failure included age over 50 years (p = 0.008), bipolar defects (p < 0.05), malaligned knees with overstressing of the grafts, and workers' compensation cases (p < 0.04). Collapse of the graft by more than 3 mm and of the joint space of more than 50% were seen more frequently in radiographs of failed grafts. Our encouraging clinical results for fresh small-fragment osteochondral allografts show that they are indicated for unipolar post-traumatic osteochondral defects of the knee in young active patients.

Adolescent↗
PubMed1997

Allograft reconstruction of the acetabulum after resection of stage-IIB sarcoma. Intermediate-term results.

Seventeen consecutive patients were managed with an allograft reconstruction of the pelvis (including the acetabulum) following resection of a stage-IIB bone sarcoma during a twelve-year period. The initial diagnosis was chondrosarcoma in nine patients, osteosarcoma in six, Ewing sarcoma in one, and leiomyosarcoma in one. All patients who had osteosarcoma or Ewing sarcoma received chemotherapy preoperatively and postoperatively. Fifteen patients were managed with an allograft-total hip prosthesis composite. Two patients initially were managed with an osteoarticular allograft without a prosthesis, but one had a subsequent revision to an allograft-implant composite. Four patients died with an intact allograft reconstruction. Eight patients survived with an intact allograft reconstruction, and they were followed for at least four years (mean, seven years; maximum, fourteen years). All but one was able to walk in the community with one or two canes at the time of the latest follow-up. There was a high rate of local recurrence, which occurred in three of the seventeen patients, and of infection, which developed in two patients. The five patients had a subsequent hindquarter amputation or removal of the allograft. The mean functional score (and standard deviation), according to the rating system of the Musculoskeletal Tumor Society, was 65 +/- 21.16 per cent (median, 70 per cent; range, 13 to 87 per cent) for the thirteen patients who were thus evaluated. Preservation of the limb and reconstruction with an allograft may be considered as an alternative to hindquarter amputation in carefully selected patients who have a bone sarcoma involving the acetabulum. However, patients who have a high-grade bone sarcoma must be warned that there is a substantial risk of local recurrence or infection. In the present series, more than half of the patients either died or had failure of the reconstruction.

Acetabulum↗
PubMed1997

Revision total knee arthroplasty of bone grafts versus implant supplementation.

Small contained bone defects can be managed by cement either with or without screws. Larger contained defects should be managed using morsellized allograft bone. Uncontained bone defects can be managed with implant supplements or structural grafts depending on the size and location of the defect. In the salvage situation, custom implants and arthrodesis may need to be considered.

Bone Cements↗
PubMed1997

Reconstruction of massive bone defects with allograft in revision total knee arthroplasty.

Allograft bone was used to reconstruct a defect in the proximal aspect of the tibia or the distal aspect of the femur, or both, in thirty knees of twenty-eight patients who had a revision total knee arthroplasty. The average age of the patients at the time of the index procedure was 65.8 years (range, twenty-four to eighty-nine years). At an average of fifty months (range, twenty-four to 132 months; median, thirty-six months) postoperatively, the score for twenty-three knees (twenty-one patients) had increased by at least 20 points, and these knees did not need additional operative treatment. Thus, the rate of success was 77 per cent. The procedure was considered a failure for the remaining seven knees because of infection (three), loosening of the tibial component (two), fracture of the graft (one), and non-union at the allograft-host junction (one). Properly applied allograft can be used to reconstruct massive bone defects, provide stability and support for implants, and restore bone stock in the event that additional operative treatment is necessary.

Adult↗