Biomedical subjects

Arthur L Malkani

Publications and source records attributed to Arthur L Malkani.

8 recordsLinked to original sources

PubMed2006

Impaction grafting for femoral component revision using a non-polished bead-blasted chrome cobalt stem-average 8 1/2-year follow-up.

Impaction grafting for femoral component revision in patients with significant bone loss has been reported using a tapered polished femoral component that is meant to subside. This study reports our results of femoral component revision using impaction grafting with a bead-blasted chrome cobalt stem designed not to subside. Forty-eight femoral component revisions using impaction grafting were retrospectively reviewed with a minimum 6 1/2-year follow-up. There were 2 failures due to aseptic loosening of the femoral component (4%). There were 22 total complications, and the overall failure rate was 21%. Impaction grafting for femoral component revision using a bead-blasted chrome cobalt stem in patients with a large femoral canal diameter has shown good results with respect to aseptic loosening with minimal subsidence.

Adult↗

PubMed2006

The trochanteric nail versus the sliding hip screw for intertrochanteric hip fractures: a review of 93 cases.

BACKGROUND: The trochanteric nail, a redesigned short gamma nail, (Howmedica, Rutherford, NJ) was introduced in the United States during 1998 for the treatment of intertrochanteric fractures. METHODS: We retrospectively reviewed 93 patients who were treated for an intertrochanteric fracture with either a sliding hip screw (SHS) or the short trochanteric nail (TN). RESULTS: In all, 94% of the patients in the sliding hip screw group healed without complication. There was one case of femoral head necrosis, one lag screw cutout, and one hardware removal for pain. Eighty-nine percent of the patients in the trochanteric nail group healed without complication. There was one late fracture at the tip of the nail, three cases of lag screw cutout, and one nonunion. CONCLUSIONS: This study suggests that the trochanteric nail is a reasonable alternative to the sliding hip screw when used for intertrochanteric fractures, although it may be associated with higher complication rates.

Aged↗

PubMed2005

Histologic and mechanical evaluation of impaction grafting for femoral component revision in a goat model.

A goat model of revision hip arthroplasty was used to examine the histology and mechanical performance of impaction grafting using two femoral stems varying in stem surface finish. There were no significant mechanical or qualitative histologic differences between smooth, tapered, polished stems and step-cut, grit-blasted stems. Allograft distribution, bone incorporation, and cement mantle thickness were not uniform within the femoral canal. Efforts to improve the impaction grafting technique may be more important than stem design.

Animals↗

PubMed2005

Damage control orthopaedics: evolving concepts in the treatment of patients who have sustained orthopaedic trauma.

In some groups of polytrauma patients, particularly those with chest injuries, head injuries, and those with mangled extremities, early total care of major bone fractures may be potentially harmful. Delaying all orthopaedic surgery, however, is also not always the best approach. In these situations, damage control orthopaedics, which emphasizes the stabilization and control of the injury rather than repair will add little additional physiologic insult to the patient and is a treatment option that should be considered.

Fracture Fixation↗

PubMed2004

Femoral component revision using an extensively hydroxyapatite-coated stem.

Femoral component revisions with extensively coated stems have shown promising clinical results, although concerns over stress shielding still exist. We retrospectively reviewed 59 patients undergoing femoral component revision with an extensively hydroxyapatite (HA)-coated stem. The average length of follow-up was 3.3 years (range, 2-5 years). The average preoperative Harris Hip Score was 43 points, which improved to 86 points at the latest follow-up (P < .01). The overall mechanical failure rate was 2%. No evidence of stress shielding was seen in 78% of patients. The clinical results of this series using an extensively HA-coated stem are similar to those using an extensively porous-coated stem. Long-term follow-up is required to determine if an extensively HA-coated implant will be superior to an extensively porous-coated implant with regard to stress shielding.

Aged↗

PubMed2004

Transfer of the long head of the triceps tendon for irreparable rotator cuff tears.

This study presents the clinical and anatomic findings of the use of the long head of the triceps tendon for treatment of massive, irreparable rotator cuff tears. The clinical study included 19 shoulders in 18 patients with a minimum followup of 2 years who were prospectively reviewed. All patients had preoperative and postoperative functional evaluations using the UCLA scoring system. The anatomic study included 20 upper extremities that had been injected with Microfil. All patients in the clinical study were satisfied with their outcome. There was an improvement in the UCLA pain and function scores. The long head of the triceps tendon is a myotendinous vascularized transfer that is a useful reconstructive procedure in patients with massive, irreparable rotator cuff tears that continue to be symptomatic despite conventional attempts at repair.

Adult↗

PubMed2003

Optimal entry point for retrograde femoral nailing.

OBJECTIVE: The purpose of this study is to identify the optimum entry point for retrograde femoral nailing, defined as that point which will provide adequate fracture alignment while minimizing soft-tissue and articular cartilage injury. DESIGN: Cadaveric study. SETTING: Biomechanics laboratory. MAIN OUTCOME MEASURE: Anatomic relationships and fracture reduction. METHODS Eleven cadaveric femori with attached knee joints underwent retrograde femoral nailing with a Synthes femoral nail (Synthes, Paoli, PA, U.S.A.). After placement of the nail, the specimens underwent an osteotomy 3 inches proximal to the articular surface. Multiple entry points were tested to determine fracture alignment and extent of articular cartilage injury. Medial-lateral and anterior-posterior displacements, in addition to any soft-tissue or articular surface trauma, were recorded for these various points of entry. RESULTS: An entry point of 1.2 cm anterior to the femoral origin of the posterior cruciate ligament resulted in the least anterior-posterior displacement of the femoral shaft following fracture. In the coronal plane, an entry point at the midpoint of the intercondylar sulcus was identified as minimizing the displacement following fracture. This ideal position allows for proper seating of the nail within the intercondylar sulcus, resulting in minimal damage to the articular cartilage and posterior cruciate ligament and minimal disruption of the patella femoral joint. CONCLUSION: Retrograde femoral nailing should be used cautiously in select patients, when conventional antegrade nailing cannot be used, due to the unavoidable injury to the knee articular surface associated with this technique. The optimum entry point of 1.2 cm anterior to the femoral posterior cruciate ligament origin and centered in the intercondylar sulcus provides the optimal balance of fracture reduction and knee joint sparing. It may be difficult to target this site with a percutaneous technique and may require direct visualization of the intercondylar sulcus for ideal nail placement.

Anterior Cruciate Ligament↗

PubMed2002

The use of the long head of triceps interposition muscle flap for treatment of massive rotator cuff tears.

Massive rotator cuff tears present a difficult problem for orthopedic surgeons. To address this problem, a long head of triceps muscle interposition flap was proposed. Ten patients underwent repair of massive rotator cuff tears using the triceps muscle flap. The patients' strength and range of motion were tested preoperatively, and a University of California, Los Angeles, shoulder score was assigned. Similar testing was performed 1 year later. Postoperatively, the patients showed significant improvement in the overall shoulder score and in the pain and function components of the score. There was no significant improvement in shoulder range of motion, except for shoulder flexion. An important finding was that there was no loss of strength in elbow extension following the loss of the long head of triceps muscle. It was concluded that the long head of triceps interposition flap is useful in the reconstruction of the massive rotator cuff tear.

Aged↗