Biomedical subjects

D D D'Lima

Publications and source records attributed to D D D'Lima.

6 recordsLinked to original sources

PubMed1998

100 cemented versus 100 noncemented stems with comparison of 25 matched pairs.

Two series of 100 consecutive primary total hip arthroplasties, each using a single design of noncemented or cemented femoral component (all 28 mm heads), were compared. One cemented and two noncemented stems underwent revision for aseptic loosening. Of unrevised hips, outcome data statistically favored cemented, rather than noncemented, stems. The data for cemented and noncemented stems, respectively, were: An excellent to good result in 97% versus 88%; thigh pain in 3% versus 40%; subsidence in 0% versus 22%; and endosteal cavitation in 6% versus 12%. For patients with 25 unrevised matched pairs, selected by gender, age, diagnosis, and weight, outcome data also statistically favored cemented over noncemented stems, respectively: an excellent or good result in 25 versus 20 hips; thigh pain in two versus eight hips; and subsidence in none versus six hips. Midterm followup data for these concurrent total hip arthroplasty series of a mid 1980s design revealed prevalence of mechanical failure of 1% for cemented stems and 4% for noncemented stems. Corroborating matched pair comparison neutralized selection bias as a causative factor for these differences. These data indicate contemporary cemented femoral stem fixation is superior to second generation noncemented femoral stem fixation. Controlled comparative studies at midterm to long term followup, such as in this report, are needed to define outcome and indications for current third generation noncemented stem fixation.

Adult↗

PubMed1998

Fatigue model to characterize cement-metal interface in dynamic shear.

This study evaluated the interface shear strength between vacuum mixed polymethyl-methacrylate and two types of surface enhancements under static and dynamic shear loading. Cobalt chrome coupons with grit blasted or light plasma sprayed surfaces were tested. For each test, two coupons were mounted in a stainless steel chamber such that they were bonded with a 2-mm cement mantle for each test. Pullout and dynamic fatigue tests were performed on an Instron machine. The mean static pullout strength of the grit blasted surfaces was 13.78 (+/- 2.73) MPa, whereas that of the light plasma sprayed surfaces was 18.46 (+/- 1.98) MPa. The rate of degradation of interface strength caused by fatigue was almost identical for both surface treatments. Qualitative analysis showed that the failed light plasma sprayed surface generated more metal and cement particles. These data suggest that light plasma sprayed surfaces sustain higher loads but have a potential for increased debris generation.

Bone Cements↗

PubMed1997

Prospective study of 100 consecutive Harris-Galante porous total hip arthroplasties. 4- to 8-year follow-up study.

This prospective study evaluates 100 consecutive Harris-Galante Porous (Zimmer, Warsaw, IN) noncemented femoral prostheses 4 to 8 years after surgery. Two femoral components were revised for aseptic loosening. The mean Harris hip score was 56 before surgery and 92 at final follow-up evaluation, with moderate thigh pain seen in 6%. Ingrowth was classified as bony (89%), stable fibrous (8%), and unstable (3%). A pedestal formed in 18%, measurable subsidence occurred in 22%, and endosteal erosion occurred in 12%. Patients with pedestal formation had a higher incidence of unstable growth pattern (P < .05). Patients with bony ingrowth had a lower mean subsidence (0.38 mm) than those with fibrous stable ingrowth (3 mm) and unstable ingrowth (7.5 mm) (P < .05). Thigh pain correlated with the type of ingrowth, and endosteal erosion with the linear polyethylene wear. Survival analysis was 97.5% at 8 years.

Adult↗

PubMed1997

Hemodilution with other blood reinfusion techniques in total hip arthroplasty.

Acute normovolemic hemodilution has been reported to result in blood savings varying from 18% to 90%. Very few of these are randomized prospective studies. This study attempts to determine the blood transfusion savings if acute normovolemic hemodilution is used in combination with autologous predonated blood and cell saver. Thirty-three patients undergoing total hip arthroplasty were assigned randomly to one of two groups (control, n = 16; hemodilution, n = 17). Patients in both groups entered an autologous predonation program if cleared medically and were placed on Cell Saver intraoperatively and in the postanesthesia care unit. In addition, the hemodilution group underwent acute normovolemic hemodilution preoperatively. Only 41% of the patients in the hemodilution group required any autologous blood transfusion as compared with 75% of the control group. In addition, the hemodilution group required a mean lower quantity of autologous blood transfusion (41% of the estimated blood loss) as compared with the control group (71%). The net anesthesia time increased by an average of 11.4 minutes in the hemodilution group. Acute normovolemic hemodilution is a safe procedure even in an older patient population. Hemodilution resulted in fewer patients needing autologous predonated blood transfusions. The major benefit of hemodilution was seen when predonation was not possible.

Adolescent↗

PubMed1996

The effect of preoperative exercise on total knee replacement outcomes.

This study compared the effects of preoperative physical therapy of general cardiovascular conditioning exercises with the routine procedure of no preoperative physical therapy on patients undergoing primary total knee replacement. Thirty patients were randomly assigned to 1 of 3 groups. Group 1 was the control group. Group 2 participated in a physical therapy program designed to strengthen the upper and lower limbs and improve knee range of motion. Group 3 participated in a cardiovascular conditioning program, consisting of arm ergometry, cycle ergometry, aquatic exercises, and aerobic activity. All patients were evaluated preoperatively and postoperatively using the Hospital for Special Surgery Knee Rating, the Arthritis Impact Measurement Scale, and the Quality of Well Being instrument. Both experimental groups tolerated their respective exercise protocols extremely well. All 3 groups showed significant improvement postoperatively as measured by the Hospital for Special Surgery Knee Rating, the Arthritis Impact Measurement Scale and the Quality of Well Being measurement scales. However, neither type of preoperative exercise added to the degree of improvement after surgery at any of the postoperative evaluations.

Aged↗

PubMed1995

Isolated lateral ring meniscus. Case report.

Reports of ring menisci are rare. This article describes a case of a congenital lateral ring meniscus and includes a literature review. The anatomy of the menisci of various vertebrates is described with an attempt to discuss the possible origin of the anomaly. Although ring menisci are asymptomatic, they are clinically significant in that they need to be differentiated from old bucket-handle tears. It is also easy to fail to visualize the intercondylar bridge between the two "horns" with conventional magnetic resonance imaging.

Aged↗