Craig D Silverton | PubMed Health

PubMed2006

Cemented and cementless fixation: results and techniques.

There are multiple reports of successful cemented and cementless total knee arthroplasty in the current literature. Although technically more demanding to implant, selected cementless designs, with nearly 20 years of follow-up, demonstrate near-equal success compared with cemented implants, the gold standard. Far more important than the decision to use a cemented or cementless implant is the use of precise technique, adequate balancing of the soft tissues, and proper overall alignment. Failure to achieve these basic principles can lead to early failure in any total knee replacement system.

Arthroplasty, Replacement, Knee↗

PubMed2003

Isolated revision of the patellar component in total knee arthroplasty.

BACKGROUND: Problems with the patellofemoral articulation are the most common causes of failure after total knee arthroplasty. However, there are few reports describing outcomes following isolated revision of the patellar component. METHODS: Forty knees with a Miller-Galante I prosthesis underwent isolated patellar revision (with or without lateral retinacular release). The Hospital for Special Surgery knee scores were collected prospectively, and radiographs made preoperatively and at the time of the final follow-up were analyzed with respect to alignment, component position, and patellar tracking. Particular attention was given to patients who had a reoperation or repeat revision and who had clinical or radiographic evidence of failure of the patellar revision. RESULTS: At a mean follow-up of sixty-two months, fifteen (38%) of the forty knees that had had an isolated revision of the patellar component failed a second time. Eight of them required a total of twelve additional operations at a mean of forty-nine months after the patellar revision. Three of the failures were severe enough to require revision of two or more of the components. Of the twenty-five knees that had not failed, the average Hospital for Special Surgery knee score at the time of the final follow-up was 87 points. Of the seven knees that did not undergo reoperation but were deemed to be failures on the basis of the patients' symptoms, the average Hospital for Special Surgery knee score at the time of the final follow-up was 72 points. CONCLUSIONS: Isolated patellar revision, with or without concurrent lateral retinacular release, was associated with a high rate of reoperation and a relatively low rate of success. Elements of the implant design and component alignment contributed to the patellar component failure; both should be scrutinized carefully in patients who are seen with this problem, prior to proceeding with isolated revision of the patellar component of a total knee arthroplasty. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series [no, or historical, control group]). See p. 2 for complete description of levels of evidence.

Adult↗

PubMedDate not supplied

Trochanteric osteotomy and fixation during total hip arthroplasty.

Once used routinely, trochanteric osteotomy in total hip arthroplasty now is usually limited to difficult primary and revision cases. There are three types: the standard trochanteric osteotomy and its variations, the trochanteric slide, and the extended trochanteric osteotomy. Each has unique indications, fixation techniques, and complications. Primary total hip arthroplasty procedures requiring the enhanced exposure provided by trochanteric osteotomy may be needed in patients with hip ankylosis or fusion, protrusio acetabuli, proximal femoral deformities, developmental dysplasia, or abductor muscle laxity. Trochanteric osteotomies in revision arthroplasties, primarily the extended trochanteric osteotomy, facilitate the removal of well-fixed femoral components, provide direct access to the diaphysis for distal fixation, and enhance acetabular exposure.

Arthroplasty, Replacement, Hip↗