PubMed Health⌕ Search

Biomedical subjects

D S Garbuz

Publications and source records attributed to D S Garbuz.

33 records · Page 2Linked to original sources
PubMed1999

The prevention of periprosthetic fractures in total hip and knee arthroplasty.

Periprosthetic fractures in total hip and total knee arthroplasty lead to considerable morbidity in terms of component fixation, bone loss, and subsequent function. The management of these fractures is technically demanding and may result in suboptimal fixation owing to poor bone stock. The prevention, early recognition, and appropriate management of such fractures are therefore critical. The pathogenesis of periprosthetic factors is multifactorial. There are a number of intrinsic patient influences such as bone stock, biomechanics, and compliance. There are also a host of extrinsic factors over which the surgeon has more control. The prevention of periprosthetic fractures requires careful preoperative planning and templating, the availability of the necessary expertise and equipment, and knowledge of the potential pitfalls so that these can be avoided both intraoperatively and in follow-up.

Acetabulum↗
PubMed1999

Classification of the hip.

A number of classification systems have been proposed for periprosthetic fractures of the femur following total hip replacement. Most of these rely purely on the site and pattern of the fracture. However, it is only after consideration of other important factors, including the stability of the prosthesis as well as the quality of the surrounding bone stock, that appropriate management can be instituted. The authors have developed a new classification system that addresses these other important factors. The authors believe that only after classifying a periprosthetic fracture with specific reference to fracture site, stability of the implant, and quality of the surrounding bone stock, can one make a rational decision towards a treatment algorithm.

Acetabulum↗
PubMed1999

The treatment of periprosthetic fractures of the femur using cortical onlay allograft struts.

Periprosthetic fractures of the femur are a complex problem to treat. Careful planning is essential before embarking on such a technically demanding procedure. There are many factors to be considered, including the premorbid condition of the patient and previous experience and training of the surgeon. Important factors relating directly to the fracture include the site, stability of the implant, and the state of the surrounding bone stock.

Animals↗
PubMed1999

The treatment of the infected hip replacement. The complex case.

The treatment of the infected total hip replacement remains expensive, leads to a long difficult course for the patient, and frequently results in a suboptimal functional outcome. Various treatment techniques are available, and may be suitable for the more straightforward case. These include one-stage exchange arthroplasty, two-stage exchange arthroplasty, resection arthroplasty, and debridement and irrigation. The complex infected total hip replacement encompasses numerous host and organism factors. These include unusual or multiple organisms, diagnostic difficulties, bone loss, immunocompromise, and reinfection. In the authors' experience, the problem of the complex infected hip replacement is best addressed using the prosthesis of antibiotic-loaded acrylic cement approach. This interval arthroplasty is a modular, custom-made, immediate fit, antibiotic selective, temporary spacer system that allows the surgeon to reconstruct even the most deficient bone stock safely and effectively using two-stage exchange arthroplasty. It affords the patient rapid pain relief, allows them to mobilize quickly while successfully eradicating infection in 96% of hips with severe bone loss, and sets an appropriate soft tissue environment for a relatively straightforward second stage procedure. The prosthesis of antibiotic-loaded acrylic cement system affords the benefits of two-stage exchange without the functional disadvantages of an excision arthroplasty particularly when the proximal femur is severely deficient. It allows flexibility for the interval period and the type of fixation used, and the potential for allograft reconstruction at the final stage.

Anti-Bacterial Agents↗
PubMed1999

Use of reconstruction rings for the management of acetabular bone loss during revision hip surgery.

Aseptic loosening remains the leading cause of failure after total hip replacement. Extensive bone loss and acetabular bone stock deficiency are frequently encountered. Simple autografting techniques are often not possible, and copious amounts of allograft may be required to reconstruct the defect. The mechanically stable environment that is a prerequisite for successful graft incorporation cannot be achieved with routine acetabular fixation techniques alone. A reconstruction ring that is secured to the surrounding pelvis provides a more rigid construct. Several types of reconstruction rings are available for the management of acetabular bone loss during revision hip surgery. Early results suggest that these devices may prove to be a useful alternative for treatment of a difficult problem.

Acetabulum↗
PubMed1999

The biology of bone grafting.

Allograft bone continues to play an important role in revision hip and knee arthroplasty with well documented clinical success. A basic understanding of allograft biology and immunology is important in order to optimize outcome. The importance of the interaction of immunologic factors with the biologic processes involved in bone graft incorporation has yet to be fully understood. A better understanding may, in the future, enable an improvement in the quality and uniformity of clinical outcome.

Animals↗
PubMed1998

Biology of allografting.

Allograft bone continues to play an important role in revision hip and knee arthroplasty. A basic understanding of allograft biology and immunology is important in order to increase the success of allografting. Although the literature has a wealth of knowledge on the subject there are still many unknowns. The role of immunology in bone transplantation has been known for a long time, but only recently has it become apparent that the bone remodeling system and the immunologic system interact to affect the clinical success of bone transplantation. Neither of these two systems are completely understood nor is their interaction. Future research in the field of bone transplantation will be aimed at a better understanding of these systems individually but, more important, how they interact in humans. Until that time, allografting still can be used with success if one understands the role of allograft biology, immunology, and the important role of the host environment in bone transplantation.

Arthroplasty, Replacement, Hip↗
PubMed1998

Seven specialized exposures for revision hip and knee replacement.

With the increasing rates and complexity of revision hip and knee arthroplasty, it has become more important than ever to approach the joint in a safe and rational manner. The development of extensile approaches have significantly simplified the removal of solidly fixed components without compromising bone stock. The extended trochanteric osteotomy enables controlled access to the femoral component and is a useful technique for revision of solidly-fixed femoral components. The trochanteric slide allows comprehensive exposure of the acetabulum and femur comparable to trochanteric osteotomy with a diminished risk of trochanteric escape. The vastus slide allows wide exposure of the femoral shaft when using an anterolateral approach. In revision total knee arthroplasty, the extensor mechanism is often at risk of disruption or avulsion, and in most cases, maneuvers that allow wide exposure of the femur and tibia while preserving the extensor mechanism are essential. Such exposures include one of the extensor mechanism reflecting techniques either proximally by rectus snip or patellar turndown, or distally by tibial tubercle osteotomy. Occasionally a femoral peel or epicondylar osteotomy is required. There should be a low threshold to consider one of these specialized approaches during revision hip and knee arthroplasty.

Acetabulum↗
PubMed1998

Role and results of segmental allografts for acetabular segmental bone deficiency.

Acetabular reconstruction in both primary and revision hip arthroplasty often requires reconstruction of deficient acetabular bone stock. The exact role of allografts remains controversial. Published results of structural allografting are presented. Recent literature supports the use of segmental allografts for reconstruction of large segmental and combined defects.

Acetabulum↗
PubMed1993

Bone grafts in hip replacement surgery. The pelvic side.

Replacement arthroplasty of the hip may require restoration of bone stock to provide support for the acetabular implant and to restore anatomy and leg lengths. This article discusses the indications, surgical technique, results, and controversies of using bulk autograft bone to provide cup support for primary hip replacement in hip dysplasia. In addition, the use of allograft bone to restore bone stock in the revision situation is covered. The indications, surgical technique, and results of the use of both morsellized and bulk allograft bone are presented.

Acetabulum↗
PubMedDate not supplied

The treatment of supracondylar fractures in children with an absent radial pulse.

The purpose of this study was to determine the outcome of patients with a supracondylar fracture and an absent radial pulse. All children with displaced extension-type supracondylar fractures from 1984-1992 were eligible. Of 326 children with supracondylar fractures, 22 had an absent radial pulse on admission. Fifteen of the 22 children had a well-perfused hand after closed reduction and K-wire fixation. Five had no pulse but a well-perfused hand after reduction and immobilization of the elbow in slight flexion; none had any problem at final review. Seven patients who had a cold white hand after closed reduction received open reduction of fracture and arterial exploration. In conclusion, the initial treatment for children with displaced supracondylar fractures with an absent radial pulse should be closed reduction, K-wire fixation, and immobilization in < 90 degrees of flexion. Children who have a well-perfused hand but an absent radial pulse after satisfactory closed reduction do not necessarily require routine exploration of the brachial artery.

Child↗