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Daniel J Berry

Publications and source records attributed to Daniel J Berry.

At least 19 recordsLinked to original sources
PubMed2006

Magnetic resonance imaging with metal suppression for evaluation of periprosthetic osteolysis after total knee arthroplasty.

Osteolysis around total knee arthroplasty (TKA) can be difficult to identify and quantitate on plain radiographs. This study reports on magnetic resonance imaging (MRI) with metal suppression for the evaluation of suspected periprosthetic osteolysis around TKA. We retrospectively reviewed 11 patients referred for MRI with suspected periprosthetic osteolysis. Radiographic and MRI findings and findings at revision arthroplasty were correlated. The presence of osteolysis was identified or suspected radiographically in all of the 11 patients. Osteolysis was confirmed in 10 patients by MRI. In 9 of 11 patients, the extent of osteolysis was greater on MRI than estimated radiographically. In 5 of 11 patients, MRI demonstrated additional osteolytic lesions which were radiographically occult. In one case, the amount of osteolysis on MRI was less than on initial radiographs, and in one case, osteolysis was felt to be present radiographically but was not confirmed on MRI. In all 7 of 11 patients subsequently treated with revision TKA, MRI findings were confirmed at revision.

Adult↗
PubMed2006

Predictors of discharge to an inpatient extended care facility after total hip or knee arthroplasty.

Increased emphasis has been placed on hospital length of stay and discharge planning after total joint arthroplasty (TJA). The purpose of this study was to identify baseline patient characteristics that are predictive of discharge to an inpatient extended care facility (ECF) after TJA. Clinical, demographic, and resource utilization data were analyzed for 7818 consecutive patients who underwent primary or revision TJA at 1 of 3 high-volume TJA centers. A stepwise linear regression model was used to identify predictors of discharge to an ECF. Overall, 29% of patients were discharged to an ECF after TJA. Older age, higher American Society of Anesthesiologists class, Medicare insurance, and female sex were all associated with a higher likelihood of discharge to an ECF. Significant differences in practice patterns were found across hospitals with respect to discharge disposition after TJA. Further study is necessary to determine the appropriate criteria for discharge to an ECF after TJA.

Adult↗
PubMed2006

Revision hip arthroplasty for late instability secondary to polyethylene wear.

We evaluated the outcome of revision arthroplasty for polyethylene wear presenting as late dislocation. The computerized databases at two institutions were reviewed to identify all patients presenting with first time dislocation five or more years after total hip arthroplasty. Records and radiographs were then evaluated, and patients whose late dislocation occurred in the presence of greater than two millimeters of polyethylene liner wear with no other etiology for dislocation were identified. There were 22 patients with a mean age of 57.8 years at primary procedure. The average time from initial arthroplasty to dislocation was 9.0 years. Revision surgery to address polyethylene wear and instability was performed at a mean of 11.1 years (range 5.8 to 23 years). Revision surgery restored stability to eighteen patients (eighty-two percent). Polyethylene wear can and is associated with late dislocation after hip arthroplasty. Exchange of polyethylene lining of a metal backed implant or revision of the all polyethylene acetabular component can successfully address late instability in the majority of patients.

Adult↗
PubMed2006

The Chitranjan Ranawat Award: Long-term survivorship and failure modes of 1000 cemented condylar total knee arthroplasties.

We examined factors affecting survivorship, and reasons for reoperation and revision of a cemented modular condylar total knee arthroplasty (TKA). One thousand and eight consecutive primary cemented cruciate-retaining TKAs performed at one institution were studied. At the time of review, 411 patients (562 knees) had died, 43 patients (45 knees) had their knee components revised or removed, and 47 patients (62 knees) were lost to followup. Mean followup of living patients with their TKA components in situ (244 patients, 331 knees) was 15.7 years. Survivorship at 15 years for revision for any reason, revision for mechanical failure, and revision for aseptic loosening were 95.9%, 97.0%, and 98.8% respectively. Survivorship was poorer among patients aged less than 60. Forty-five knees had components removed or revised; approximately one-third were removed for infection, one-third for aseptic loosening or tibial polyethylene wear, and one-third for other causes. Mechanical implant failures accounted for less than one-half of the reoperations and revisions, while infection and periprosthetic fractures accounted for a substantial portion of revisions and reoperations. Because mechanical arthroplasty failures have become less common, other complications related to arthroplasty have become proportionately more frequent.

Adolescent↗
PubMed2006

Anesthetic, patient, and surgical risk factors for neurologic complications after prolonged total tourniquet time during total knee arthroplasty.

Nerve injury after prolonged tourniquet inflation results from the combined effects of ischemia and mechanical trauma. Tourniquet release, allowing a reperfusion interval of 10-30 min followed by re-inflation, has been recommended to extend the duration of total tourniquet time. However, this practice has not been confirmed clinically. We retrospectively reviewed the medical records of 1001 patients undergoing 1166 primary or revision knee replacements with tourniquet time more than 120 min during a 5-yr interval. Mean total tourniquet time was 145 +/- 25 min (range, 120-308 min). In 759 patients, the tourniquet inflation was uninterrupted. Two tourniquet inflations, interrupted by a single deflation, were noted in 371 patients, and 3 tourniquet inflations interrupted by 2 deflation intervals were noted in 23 patients. A total of 129 neurologic complications (peroneal and/or tibial nerve palsies) were noted in 90 patients for an overall incidence of 7.7%. Eighty-five cases involved the peroneal nerve and 44 cases involved the tibial nerve. In 39 cases, both peroneal and tibial deficits were noted. Complete neurologic recovery occurred in 76 (89%) peroneal and 44 (100%) tibial palsies. Postoperative neurologic dysfunction was associated with younger age (P < 0.001; odds ratio = 0.7 per 10-yr increase), longer tourniquet time (P < 0.001; odds ratio = 2.8 per 30-min increase), and preoperative flexion contracture >20 degrees (P = 0.002; odds ratio = 3.9). In a subset of 116 patients with tourniquet times > or =180 min, longer duration of deflation was associated with a decreased frequency of neurologic complications (P = 0.048). We conclude that the likelihood of neurologic dysfunction increases with total tourniquet time and that a reperfusion interval only modestly decreases the risk of nerve injury.

Aged↗
PubMed2005

Total knee arthroplasty for salvage of failed internal fixation or nonunion of the distal femur.

Seventeen patients with a mean age of 66 years had total knee arthroplasty (TKA) performed to salvage failed internal fixation or nonunion of the distal femur. Two patients died at less than 2 years, both of whom were unrevised. The remaining 15 were followed for a mean of 5 years. Three arthroplasties failed, 1 by infection and 2 by mechanical failure. The 5-year survivorship free of revision for aseptic failure was 91% (72%-100%). There were 5 intraoperative complications (29%) and 5 postoperative complications (29%). The mean Knee Society pain score improved from 2 (range, 0-10) to 89 (range, 63-97), and the mean functional score improved from 2 (range, 0-25) to 45 (range, 10-90). TKA provided reliable pain relief and functional improvement for the great majority of patients. Functional scores and prosthesis survivorship, however, were inferior to those reported for primary TKA. The surgeries were difficult, and intraoperative and postoperative complications were common.

Adult↗
PubMed2005

Extended femoral osteotomy for revision of hip arthroplasty: results and complications.

Seventy-five revision total hip arthroplasties (73 patients) performed using an extended greater trochanteric osteotomy for exposure and an extensively porous-coated uncemented stem were reviewed after 2 years (range, 1 to 5). The mean osteotomy length was 14 cm (range, 7 to 19 cm) and fixation was with at least 2 cables. One stem was revised at 4 months for stem subsidence and loosening. Of the remaining 74 osteotomies, 73 healed without further procedures. A single nonunion was reoperated at 4 months and healed. Sixty-eight of 73 osteotomies healed with no migration and 5 did with less than 5 mm of proximal migration of the osteotomy fragment. Complications included 3 intraoperative and 1 postoperative osteotomy fragment fractures. Extended trochanteric osteotomy, executed preserving the fragment's vascularity and fixed with rigid fixation, can be performed with a low rate of complications.

Adult↗
PubMed2005

Autogenous femoral head bone grafts for acetabular deficiency in total-hip arthroplasty for developmental dysplasia of the hip: long-term effect on pelvic bone stock.

Twenty-eight primary total-hip arthroplasties in 23 patients performed with autogenous femoral head bone graft augmentation for developmental hip dysplasia were retrospectively reviewed at 8 to 15 years. Five sockets were revised for different reasons. At revisions, 3 grafts were healed, the other 2 had substantial resorption. Immediately postoperatively, the mean medial to lateral graft thickness at the level of the superior border of the socket was 33 mm. Radiographs a mean of 4.8 years after operation demonstrated this thickness decreased by a mean of 1 mm (range, 0-10 mm). At 11 years (range, 8-15 years), radiographs in unrevised hips showed no cases of substantial further graft resorption.

Acetabulum↗
PubMed2005

Total knee arthroplasty in patients with Paget's disease of bone at the knee.

The purpose of this study was to identify the technical difficulties, complications, and long-term outcome of total knee arthroplasty in patients with Paget's disease. Twenty consecutive patients (21 knees) with Paget's disease at the knee who underwent primary total knee arthroplasty were retrospectively reviewed. All arthroplasties employed cemented condylar implants. Two patients died at less than 2 years and one was lost to follow-up; the remaining 17 (18 knees) were followed for an average of 9 years. Mean Knee Society scores for pain and function improved from 41 and 36 points preoperatively to 87 and 67 points, respectively, postoperatively. One patient underwent femoral revision for aseptic loosening at 10 years. None developed substantial heterotopic ossifications or deep infection. Total knee arthroplasty in patients with Paget's disease can provide good clinical results with low revision rate and good implant durability, despite technical challenges.

Aged↗
PubMed2005

Total joint arthroplasty in patients with osteopetrosis: a report of 5 cases and review of the literature.

Osteopetrosis, an inherited disorder of bone metabolism, is associated with multiple musculoskeletal complications. Two of these problems, osteoarthritis and periarticular nonunions, may be considered for treatment with total joint arthroplasty. However, there is little information on the early and longer-term results, complications, and technical difficulties related to performing arthroplasty in patients with osteopetrosis. We report the results of 3 total hip arthroplasties and 2 total knee arthroplasties in patients with osteopetrosis. These cases in combination with a literature review provide further insight into results, complications, and technical challenges of performing total joint arthroplasty in patients with osteopetrosis.

Adult↗
PubMed2005

What would you do? Case challenges in hip surgery.

Evaluation and management of 4 challenging hip case scenarios were discussed in an interactive session with a moderator and 5 experts in hip reconstruction. Case-based discussion included total hip arthroplasty for posttraumatic arthritis after acetabular fracture, total hip arthroplasty after failed intertrochanteric hip fracture, total hip arthroplasty for hip dysplasia, and total hip arthroplasty in the case of proximal femoral deformity.

Acetabulum↗
PubMed2005

Differences in patient and procedure characteristics and hospital resource use in primary and revision total joint arthroplasty: a multicenter study.

A multicenter retrospective cost-identification cohort study was undertaken to analyze clinical, demographic, and economic data for 4533 consecutive total hip arthroplasty (THA) and 3508 consecutive total knee arthroplasty (TKA) procedures performed during a 3-year period in 1 of 3 hospitals. Statistically significant differences were found between primary and revision procedures with respect to patient age, sex, payer type, mean total operative time, use of allograft, average length of hospital stay, discharge disposition, and hospital costs. Significant differences were also found between different types of revision total joint arthroplasty (TJA) procedures. Our findings could be used to help improve the accuracy of administrative claims data related to primary and revision TJA procedures to identify relevant differences in patient characteristics, procedure characteristics, and hospital resource use.

Aged↗
PubMed2005

Technical note: validation of a motion analysis system for measuring the relative motion of the intermediate component of a tripolar total hip arthroplasty prosthesis.

Tripolar total hip arthroplasty (THA) prosthesis had been suggested as a method to reduce the occurrence of hip dislocation and microseparation. Precisely measuring the motion of the intermediate component in vitro would provide fundamental knowledge for understanding its mechanism. The present study validates the accuracy and repeatability of a three-dimensional motion analysis system to quantitatively measure the relative motion of the intermediate component of tripolar total hip arthroplasty prostheses. Static and dynamic validations of the system were made by comparing the measurement to that of a potentiometer. Differences between the mean system-calculated angle and the angle measured by the potentiometer were within +/-1 degrees . The mean within-trial variability was less than 1 degrees . The mean slope was 0.9-1.02 for different angular velocities. The dynamic noise was within 1 degrees . The system was then applied to measure the relative motion of an eccentric THA prosthesis. The study shows that this motion analysis system provides an accurate and practical method for measuring the relative motion of the tripolar THA prosthesis in vitro, a necessary first step towards the understanding of its in vivo kinematics.

Algorithms↗
PubMed2005

Effect of femoral head diameter and operative approach on risk of dislocation after primary total hip arthroplasty.

BACKGROUND: It has been postulated that use of a larger femoral head could reduce the risk of dislocation after total hip arthroplasty, but only limited clinical data have been presented as proof of this hypothesis. METHODS: From 1969 to 1999, 21,047 primary total hip arthroplasties with varying femoral head sizes were performed at one institution. Patients routinely were followed at defined intervals and were specifically queried about dislocation. The operative approach was anterolateral in 9155 arthroplasties, posterolateral in 3646, and transtrochanteric in 8246. The femoral head diameter was 22 mm in 8691 of the procedures, 28 mm in 8797, and 32 mm in 3559. RESULTS: One or more dislocations occurred in 868 of the 21,047 hips. The cumulative risk of first-time dislocation was 2.2% at one year, 3.0% at five years, 3.8% at ten years, and 6.0% at twenty years. The cumulative ten-year rate of dislocation was 3.1% following anterolateral approaches, 3.4% following transtrochanteric approaches, and 6.9% following posterolateral approaches. The cumulative ten-year rate of dislocation was 3.8% for 22-mm-diameter femoral heads, 3.0% for 28-mm heads, and 2.4% for 32-mm heads in hips treated with an anterolateral approach; 3.5% for 22-mm heads, 3.5% for 28-mm heads, and 2.8% for 32-mm heads in hips treated with a transtrochanteric approach; and 12.1% for 22-mm heads, 6.9% for 28-mm heads, and 3.8% for 32-mm heads in hips treated with a posterolateral approach. Multivariate analysis showed the relative risk of dislocation to be 1.7 for 22-mm compared with 32-mm heads and 1.3 for 28-mm compared with 32-mm heads. CONCLUSIONS: In total hip arthroplasty, a larger femoral head diameter was associated with a lower long-term cumulative risk of dislocation. The femoral head diameter had an effect in association with all operative approaches, but the effect was greatest in association with the posterolateral approach.

Aged↗
PubMed2005

Early postoperative transverse pelvic fracture: a new complication related to revision arthroplasty with an uncemented cup.

BACKGROUND: Uncemented hemispherical cups are commonly used to revise failed acetabular total hip components, even in the presence of marked acetabular bone loss. The purpose of the present study was to report a new complication of acetabular component revision with an uncemented hemispherical cup. METHODS: We retrospectively reviewed the records of seven patients (seven hips) in whom an early postoperative transverse acetabular fracture had developed following the implantation of an uncemented trabecular metal cup for the revision of a failed acetabular component. All patients were female. The average age was 63.6 years. The reason for acetabular revision was aseptic loosening of the original cup in five patients and reimplantation after a previous resection arthroplasty in the remaining two. The average cup size used for revision was 58 mm. In two hips, additional modular acetabular metal augments were used to restore the acetabular rim. RESULTS: The average postoperative time to diagnosis of a transverse acetabular fracture was eight months. Five of the seven patients presented with a marked acute increase in pain and a new displaced transverse acetabular fracture (pelvic discontinuity) that was visible on plain radiographs. Two patients were asymptomatic but had a nondisplaced transverse acetabular fracture. In all seven patients, the trabecular metal socket appeared radiographically to be well fixed to part of the pelvis. The five patients with a displaced fracture were managed with additional surgery to stabilize the fracture. CONCLUSIONS: To our knowledge, early postoperative transverse pelvic fractures following revision of the acetabular component have not been reported previously. The most likely causes of this complication are further weakening of the remaining pelvic bone stock as a result of the reaming required to obtain a secure fit of a large-diameter hemispherical socket and the cyclic stresses on the weakened bone with resumption of walking. It is unlikely that the fractures occurred intraoperatively because in each case the socket remained well fixed to one of the pelvic fragments.

Adult↗
PubMed2005

Operative management of displaced femoral neck fractures in elderly patients. An international survey.

BACKGROUND: Hip fractures occur in 280,000 North Americans each year. Although surgeons have reached consensus with regard to the treatment of undisplaced fractures of the hip, the surgical treatment of displaced fractures remains controversial. Identifying surgeons' preferences in techniques, and the rationale for their choices, may aid in focusing educational activities to the orthopaedic community as well as planning future clinical trials. Our objective was to clarify current opinion with regard to the operative treatment of displaced fractures of the femoral neck. METHODS: We used a cross-sectional survey design and a sample-to-redundancy strategy to examine surgeons' preferences in the treatment of displaced femoral neck fractures. We mailed this survey to members of the Orthopaedic Trauma Association and European-AO International-affiliated trauma centers. RESULTS: Of 442 surgeons who received the questionnaire, 298 (67%) responded. The typical respondent was a North American man over the age of forty years who was in academic practice, supervised residents, had fellowship training in trauma, and worked in a low-volume center (<100 hip fractures per year), treating an equal proportion of displaced and undisplaced femoral neck fractures. Most surgeons believed that internal fixation was the procedure of choice in younger patients (those who are less than sixty years old) with a displaced fracture (Garden type III or IV). For patients over eighty years old with Garden type-III or IV fractures, almost all surgeons preferred arthroplasty. Respondents varied widely in their preferences for the treatment of patients who were sixty to eighty years old with a displaced fracture (Garden type III or IV) or active patients with a Garden type-III fracture. Many surgeons believed there was no difference between arthroplasty and internal fixation when considering mortality (45%), infection rates (30%), and quality of life (37%). Surgeons also revealed variable preferences in their choice of the optimal approach to arthroplasty for patients between sixty and eighty years old with a type-IV fracture (32% preferred unipolar; 41%, bipolar; and 17%, total hip arthroplasty) and in the optimal choice of implant for internal fixation. CONCLUSIONS: While surgeons prefer internal fixation for younger patients and arthroplasty for older patients, they disagree about the optimal approach to the management of patients between sixty and eighty years old with a displaced fracture and active patients with a Garden type-III fracture. Surgeons also disagree on the optimal implants for internal fixation or arthroplasty.

Adult↗