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Biomedical subjects

B M Wroblewski

Publications and source records attributed to B M Wroblewski.

At least 91 records · Page 5Linked to original sources
PubMed1995

Multiple revision for failed Charnley low-friction arthroplasty.

We reviewed 54 patients at a mean follow-up of 4 years 4 months after rerevisions for failure of Charnley low-friction arthroplasty. Rerevision for aseptic loosening in 26 hips was satisfactory; there were no clinical failures and at the latest radiological assessment only one stem and three sockets showed signs of loosening. By contrast, nine of 20 multiple revisions for recurrent dislocation failed, as did five of eight multiple revisions for deep infection. There was radiological evidence of loosening in one stem and nine sockets in the former group and in three stems and five sockets in the latter.

Adult↗
PubMed1995

Cemented revision for aseptic acetabular loosening. A review of 387 hips.

We reviewed the records and radiographs of 387 cemented revisions of aseptic loose sockets after total hip replacement at a mean follow-up of 5.5 years. The clinical results were satisfactory, but at the last radiological assessment 38 sockets (9.8%) had a continuous zone of demarcation greater than 1 mm thick and another 35 (9%) showed migration. Poor acetabular bone stock had a profound influence on the outcome of revision surgery, but the results of cemented revision were comparable to those reported for cementless revision at similar mean follow-up.

Acetabulum↗
PubMed1995

Cemented Charnley revision arthroplasty for severe femoral osteolysis.

We reviewed prospectively cemented stem revision in 106 patients with severe femoral endosteal bone lysis without infection. Bone grafts were not used in any of the patients. The minimum follow-up was three years (mean 6 years 4 months). At the last review 76.4% of the patients were free of pain and 17.9% had only mild or occasional discomfort; radiographs showed well-fixed stable stems in 101 (95.3%). An intramedullary cement plug was used at revision to improve stability in 97.7%. There was new endosteal osteolysis after revision in 17 patients; only two had severe changes. Seven hips (6.6%) required a second revision; only four of these (3.8%) were for stem loosening. Survivorship of the revised stem, using radiological evidence of stem loosening as the end point, was 95.8% at seven years. The results of stem revision arthroplasty using cement in the presence of massive endosteal cavitation are satisfactory.

Adult↗
PubMed1995

Revision for aseptic stem loosening using the cemented Charnley prosthesis. A review of 351 hips.

We reviewed 351 cemented revisions of femoral stems performed for aseptic loosening. At a mean of six years after the revision operation 72.1% of the patients were pain-free and 21.4% had only mild or occasional discomfort. The latest radiographs showed definite stem loosening in 10 (2.8%) and 20 hips (5.7%) had required rerevision, only nine (2.6%) of which were for mechanical failure of the stem. Survivorship analysis, taking the end point as rerevision of the stem, gave 97.0% survival at eight years and 91.6% at 11 years. Excellent results both clinically and radiologically can be achieved by cemented revision of the femoral stem for aseptic loosening.

Adult↗
PubMed1994

Activity and socket wear in the Charnley low-friction arthroplasty.

A clinical study was undertaken to assess the influence of patient-related factors on wear of the socket in Charnley low-friction arthroplasty. One hundred nine arthroplasties in 79 patients were reviewed at an average of 10.3 years. A new method of activity assessment was designed and used to estimate the distance walked by each patient. This method was validated by a pedometer that recorded the time taken by each patient to walk 20 m. Activity level was related to the amount of movement at the level of the prosthetic articulation by calculating the sliding distance of a point at the center of the surface of the head of the femoral component. Wear was found to correlate with patient activity, but not with the physical characteristics of the patient or the time since operation.

Activities of Daily Living↗
PubMed1994

Bulk autograft for a deficient acetabulum in Charnley low-friction arthroplasty. A 2-9-year follow-up study.

The authors assessed 40 hips in 36 patients where a bulk femoral head autograft was used to supplement deficient acetabulum while performing Charnley low-friction arthroplasty. The majority of the hips were congenitally dysplastic or dislocated with secondary arthritis. The average age at surgery was 47.5 years and the average follow-up period was 4 years. The graft provided a cover between 10 and 42% (mean, 23%) of the socket hemisphere. Union of the graft was evident on the radiograph in 35 hips. There was no graft resorption in 28 hips. Mild graft resorption was seen in 11 cases, and moderate graft resorption was seen in 1 case. In 24 cases, there was no demarcation at the bone-cement interface of the socket. Asymptomatic demarcation of 1 mm thickness or less was seen in 16 hips, of which only 2 showed demarcation at the cement-graft interface. All 40 cases were clinically asymptomatic and successful thus far, with the mean d'Aubigne and Postel score improving from 3.1, 2.8, and 2.9 before surgery to 5.9, 5.4, and 4.9 after surgery for pain, function, and movement, respectively.

Acetabulum↗
PubMed1994

Cemented revision Charnley low-friction arthroplasty in patients with rheumatoid arthritis.

We assessed 41 patients with rheumatoid arthritis (47 hips) who had had revision hip arthroplasty, at an average follow-up of 7 years 4 months (2 to 19). The clinical results were excellent or satisfactory in 43 hips. Radiologically, 45 stems were secure. Fifteen sockets (36.6%) were radiologically loose. Three hips required rerevision. Socket failure is the predominant problem in rheumatoid patients after cemented revision arthroplasty.

Adult↗
PubMed1994

One-stage revision of infected total hip replacements with discharging sinuses.

We report a prospective study of 57 one-stage cemented revisions of total hip replacement for deep infection with an actively discharging sinus. The average follow-up was 7 years 4 months. Seven patients had required rerevisions, but at latest follow-up, infection was under control in 49 (86%). A discharging sinus is not, in itself, a contraindication to one-stage revision of a hip replacement.

Adolescent↗
PubMed1994

Long-term results of cemented Charnley revision arthroplasty for fractured stem.

A prospective study of 125 cemented revisions for fractured stem, with a minimum follow-up time of one year nine months and a mean follow-up time of eight years, was performed. All arthroplasties were revised using Charnley components. At the most recent follow-up evaluation, 67.2% of patients were pain free and 22.4% had only mild or occasional discomfort. Radiographically, 107 stems (85.6%) were well fixed, six (4.8%) were definitely loose, and 12 (9.6%) were possibly loose. Thirteen hips (10.4%) required a further revision. Survivorship of the stem at the end of 11 years was 90.4%. Long-term results of cemented revision for fractured stem are very satisfactory.

Adult↗
PubMed1994

Osteolysis due to particle wear debris following total hip arthroplasty: the role of high-density polyethylene.

It seems likely that the osteolysis seen in total hip arthroplasty, and commonly attributed to wear debris, is actually caused by changes of volume and pressure in the cavity housing the implant. Improvements in cementing technique reduce the incidence of osteolysis. There is no evidence to suggest that this osteolysis is a biological response to wear debris or that the process is different on the femoral and the acetabular side. Similar changes can be seen on both sides of an arthritic hip joint that has not been subjected to surgery.

Biocompatible Materials↗
PubMed1993

Revision hip arthroplasty. Can the octogenarian take it?

Fifty-six patients over the age of 80 undergoing revision hip arthroplasty in 57 hips were reviewed. The average age of the patients at the time of surgery was 81 years 6 months and the mean follow-up period was 2 years 6 months. No complications were seen in 21 patients. The complication encountered in the others were medical in 35 and procedure-related in 15. The preoperative risk factor rating (American Society of Anesthesiologists classification) correlated very well with the incidence and grading of medical complications. This correlation was significant, emphasizing the importance of strict preoperative medical and anesthetic assessment in this group of patients. The mean d'Aubigne and Postel hip score improved from 2.8, 2.2, and 3.4 to 5.6, 4.8, and 4.9 after revision surgery.

Aged↗
PubMed1993

Femoral head autograft and contralateral total hip arthroplasty.

Femoral head autograft from a primary total hip arthroplasty side was used to supplement deficient bone stock on the contralateral revision side. Five patients (10 operations) were treated; all had excellent clinical results and full incorporation of the graft. The methods of treatment was found to be suitable in selected patients.

Adult↗
PubMed1993

Flanged acetabular components in cemented Charnley hip arthroplasty. Ten-year follow-up of 350 patients.

A flanged socket was introduced by Sir John Charnley for use in his low-friction hip arthroplasty in 1976. Experimental evidence has suggested that the flange offers an advantage in terms of cement pressurisation at the time of implantation. We have reviewed 302 primary Charnley arthroplasties followed for 9 to 11 years to determine the effect of the flanged socket on the radiological appearance. The incidence of radiological demarcation at the cement-bone interface is significantly reduced in early radiographs after the use of a flanged socket, and the advantage is maintained in the long-term results.

Bone Cements↗
PubMed1993

Reduction of postoperative blood loss after press-fit condylar knee arthroplasty with use of a femoral intramedullary plug.

In a prospective study of eighty press-fit condylar knee arthroplasties performed with cement, we compared the postoperative blood loss in forty patients in whom the defect left by the femoral intramedullary alignment rod had been left open with the blood loss in forty patients in whom the defect had been closed with a plug of cement. The patients in the open-defect group had significantly more blood loss (mean, 1002 milliliters) in the first twenty-four hours after the operation than the closed-defect group (mean, 752 milliliters) (p < or = 0.01). The total postoperative blood loss was also significantly greater in the open-defect group (mean, 1536 milliliters) than in the closed-defect group (mean, 1215 milliliters) (p = 0.02).

Adult↗
PubMed1993

Cementless versus cemented total hip arthroplasty. A scientific controversy?

The controversy surrounding cementless versus cemented total hip arthroplasty cannot be resolved at this stage on a strictly scientific basis. Various aspects of this controversy are presented. The focus of some specific discussion sections include acrylic cement, component design of both the socket and the stem, and function and wear.

Bone Cements↗
PubMed1993

Psoas tenotomy and heterotopic ossification after Charnley low-friction arthroplasty.

One hundred twelve cases of Charnley low-friction arthroplasty (LFA), with elevation of the psoas tendon from the lesser trochanter, were reviewed. Twenty-six (23.3%) had heterotopic ossification in that area. No heterotopic ossification was present in 124 cases without psoas tenotomy. Periosteal elevation at the time of tenotomy is a likely cause of psoas heterotopic ossification.

Adult↗