Pelvic osteolysis associated with an uncemented acetabular component in total hip arthroplasty.
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Acetabulum↗
Biomedical subjects
B F Kavanagh
Publications and source records attributed to B F Kavanagh.
Charnley low-friction arthroplasty of the hip. Twenty-year results with cement.
The first 333 Charnley (Thackray, United Kingdom) total hip arthroplasties performed at the Mayo Clinic between 1969 and 1970 have been followed since that time. One hundred twelve patients (112 hips) remain alive at 20 years. Clinical results remain excellent. The Mayo clinical and roentgenographic hip scoring system rates the results as good to excellent in 39 of 69 hips (with all necessary data to calculate the entire score), fair in 13 hips, and poor in 17 hips. The clinical score alone showed satisfactory results in 77 of 112 hips. Some clinical deterioration was attributed to the advancing age of the patients (mean age at final follow-up evaluation, 84 years). Probable roentgenographic loosening (component migration, complete bone-cement interface, radiolucent line greater than 1 mm, cement fracture) was noted in 12 of 69 acetabular components (17%) and 28 of 69 femoral components (36%). Two patients had required revision since the last report at 15 years for a total of 38 patients (32 revised, 4 Girdlestone arthroplasties, 2 stem fractures not yet revised). The probability of surviving 20 years without revision of the components was 84% (83% for men, 85% for women). The rates of loosening, revision, and failure (revision, Girdlestone, or symptomatic loosening) remain linear over 20 years of follow-up evaluation. If the probability of revision is based on patient age at the time of the initial total hip arthroplasty, there is a significantly increased probability of revision in those patients less than 59 years of age (27%) compared to those 59-65 years of age (13%), 65-70 years (7.5%), and over 70 years (12%).
Aged↗
Open reduction and internal fixation of displaced intra-articular fractures of the glenoid fossa.
Ten displaced intra-articular fractures of the glenoid fossa were treated with open reduction and internal fixation between 1980 and 1987. Nine patients were available for evaluation at an average of four years (range, two to ten years) after the operation. Eight patients had mild or no symptoms and little or no restriction of the motion of the shoulder. There were no infections or malunions. The only complication was heterotopic ossification in one patient. Radiographic evaluation showed no evidence of traumatic osteoarthrosis in any patient. Open reduction and internal fixation is a useful and safe technique for the treatment of selected, displaced fractures of the glenoid fossa, and it can restore excellent function of the shoulder.
Adult↗
Complications with revision of the femoral component of total hip arthroplasty. Comparison between cemented and uncemented techniques.
The intraoperative and early postoperative complications of femoral component revision surgery in a group of 94 treated with a cemented femoral implant and 91 treated with a specific (Bias, Zimmer International, Warsaw, IN) uncemented femoral implant were assessed. Follow-up of at least 2 years for both groups was obtained, averaging 4.5 years and 3.2 years, respectively. The Harris hip score was 45 and 81 before and after the cemented revision and 42 and 84 for the uncemented procedure. The overall complication rate was 41% and 34%, respectively, which is not statistically different. The major differences consist of radiographic evidence of probable loosening in 53% of the cemented population and at least 2 mm of subsidence in 45% of the uncemented group. Fracture occurred in 3% and 18%, respectively, and caused failure in one with cemented and three with uncemented revisions. The reoperation rate was 15% and 12%, respectively. In these patient populations, uncemented femoral revision was a satisfactory technique, having a complication rate comparable to and radiographic features more favorable than what was present with the cemented revision procedure. Long-term follow-up is necessary to determine more fully the role of uncemented implants for femoral component revision.
Cementation↗
Femoral fractures associated with total hip arthroplasty.
Intraoperative and postoperative fractures of the femur during total hip arthroplasty have become more frequent complications with the advent of pressfit femoral components. Principles of rigid fixation of both the prosthesis and the fracture must be followed to achieve a satisfactory result. Methods of prevention of these complications are highlighted but there still exists a risk of femoral fracture in many clinical settings.
Femoral Fractures↗
Charnley total hip arthroplasty with cement. Fifteen-year results.
The results of the first 333 Charnley total hip arthroplasties that were performed with cement at the Mayo Clinic were reviewed a minimum of fifteen years postoperatively. Data were available for 166 of 170 hips of patients who were still alive. One hundred and thirty patients died, and thirty-seven hips were revised. At the time of this study, 80 per cent of the living patients had no pain, and 152 of the 160 hips remained much better than before the operation. Kaplan-Meier analysis of probable loosening of one or both components, on the basis of roentgenographic evidence, demonstrated a probability of loosening of 3 per cent incidence at one year after operation, 13 per cent at five years, 19 per cent at ten years, and 32 per cent at fifteen years. The probability of failure (that is, revision or symptomatic loosening) was 0.9 per cent at one year, 4.1 per cent at five years, 8.9 per cent at ten years, and 12.7 per cent at fifteen years. We did not identify a dramatic increase in the incidence of loosening or failure at any of the follow-up periods (one, five, ten, or fifteen years). With the Mayo Clinic clinical and roentgenographic system for scoring the hips, we found that ninety-seven hips had a good or excellent result; fifteen, a fair result; and thirteen, a poor result. (The scoring could not be completed for forty-one hips). The functional results deteriorated slightly over time.(ABSTRACT TRUNCATED AT 250 WORDS)
Activities of Daily Living↗
The uncemented total hip arthroplasty. Intraoperative femoral fractures.
Intraoperative fractures of the proximal femur occurred in 40 (38 patients) of 630 (6.3%) biological ingrowth total hip arthroplasties performed between January 1984 and July 1986. Twenty-three of these fractures occurred during 131 revision arthroplasties (17.6%) and 17 during 499 primary arthroplasties (3.5%). All but two of the fractures were recognized during surgery. Thirty-seven were treated with either Parham bands or cerclage wires. Bone graft was added to the fracture site in 31 fractures. All of the fractures healed. Three of the patients failed to achieve stable fixation and have required revision surgery. An additional patient has thigh pain with 2 mm of subsidence noted with serial roentgenographs. Femoral fractures can be prevented by preoperative templating of roentgenograms containing markers to measure magnification, routine overreaming of the femoral canal when implanting long-stemmed prostheses, and prophylactically applying wires or bands to femurs requiring the removal of screws.
Bone Cements↗
Cementless joint replacement: current status and future.
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Bone Cements↗
Multiple revisions for failed total hip arthroplasty not associated with infection.
Forty-five patients (forty-five hips) underwent repeat revisions of a total hip arthroplasty that had failed but was not associated with infection; seven of these patients had a third revision. The mean length of follow-up was approximately three years, and no patients were lost to follow-up. Twenty-eight of the forty-five patients had no or slight pain after the second revision, and thirty reported that their condition was improved. After the third revision, six patients had no or only slight pain, and five said that their condition was improved. On final roentgenographic examination, there was probable loosening (migration or subsidence of a component, lucency at the prosthesis-cement interface, fracture of the cement, or complete radiolucency at the bone-cement, or complete radiolucency at the bone-cement interface of more than one millimeter in at least one zone) of eight of the acetabular components and thirteen of the femoral components after the second revision and three acetabular components and one femoral component after the third. There was symptomatic loosening (moderate or severe pain and probable roentgenographic loosening) in six patients after the second revision and one after the third. Significant postoperative complications were noted in nineteen of the forty-five patients, and treatment was considered to be a failure in eleven hips after the second revision and in two after the third.
Adult↗
Post-traumatic spinal-cord cyst. A case report.
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Adult↗
Anterior shoulder instability.
Techniques of reduction include direct pressure on the humeral head, leverage through the arm, and traction maneuvers. Reduction should be expeditious but gentle. The modified Stimson, abduction, and scapular manipulation methods are effective and safe--not requiring forceful pressure or leverage. Controversy continues about postreduction immobilization and rehabilitation. In younger persons (less than 30 years of age), especially athletes, the literature supports 3 to 6 weeks of immobilization followed by an extensive rehabilitation program and avoidance of sports for at least 2 to 3 months. Many factors enter into the selection of a repair method for recurrent anterior instability. They tend to favor a method that will allow identification of the pathologic condition and treatment of the Bankart lesion or capsular laxity, if present, without concomitant use of metallic internal fixation. One such repair technique is illustrated in a step-by-step sequence.
Adult↗
Clinical and roentgenographic assessment of total hip arthroplasty. A new hip score.
A new total hip scoring system is presented and applied in a group of patients who were treated by revision of total hip arthroplasty. The Mayo hip score combines clinical (80 points) and roentgenographic (20 points) data in a 100-point score. The roentgenographic input into the score decreased the percentage of good-to-excellent results because of the high frequency of roentgenographic signs of loosening. With the Harris rating, there were 63% good-to-excellent results, 12% fair results, and 26% poor results a mean of 4.25 years after component revision of total hip arthroplasty. With the Mayo system, there were 52% good-to-excellent results, 19% fair results, and 29% poor results a mean of 4.25 years after revision. A modification of the roentgenographic rating system would apply the Mayo hip score to noncemented total hip arthroplasties.
Canes↗
Revision total hip arthroplasty.
Two hundred and ten hips in 206 patients who had an initial total hip arthroplasty performed at the Mayo Clinic between 1969 and 1978 required revision of the arthroplasty at the Mayo Clinic for reasons other than infection. One hundred and sixty-two of the patients (166 hips) were followed both clinically and roentgenographically for two years or more. One hundred and forty-five (90 per cent) reported that they had improvement after the surgical revision. Complications that occurred with revision included deep sepsis, superficial would infection, dislocation, intraoperative femoral fracture, and postoperative femoral fracture. Roentgenographic analysis showed probable loosening in thirty-three acetabular components (20.1 per cent) and seventy-two femoral components (44 per cent). Symptomatic loosening (moderate to severe pain and probable roentgenographic loosening) was seen in thirty-five patients. Eight patients required a second revision for this reason, and seven others required a second revision for other reasons. Modified Harris hip scores, calculated for 108 hips, showed a good or excellent result in sixty-seven hips (62 per cent), a fair result in twelve (11 per cent), and a poor result in twenty-nine (27 per cent). Using a new Mayo Clinic hip score that incorporates roentgenographic data (which will be described) in the evaluation of 165 revised hips, there was a good or excellent result in eighty-five (52 per cent), a fair result in thirty-two (19 per cent), and a poor result in forty-eight hips (29 per cent). Although 90 per cent of the patients thought that their condition had improved, the high incidence of roentgenographic signs of probable loosening of a component is of serious concern.
Activities of Daily Living↗
Extension contracture of the wrist: a case report.
Progressive extension contracture of the wrist of a 19-year-old female patient was noted at operation to be due to shortening of the extensor carpi radialis longus and extensor carpi radialis brevis. Satisfactory wrist motion was restored with Z-plasty tendon lengthening of these two muscles. There was no apparent abnormality of the muscle bellies and no identifiable cause of the muscular contracture. A review of the literature revealed no previously reported cases of this kind.
Adult↗