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Biomedical subjects

Daniel J Berry

Publications and source records attributed to Daniel J Berry.

At least 55 records · Page 3Linked to original sources
PubMed2003

Salvage of failed internal fixation of intertrochanteric hip fractures.

Most intertrochanteric hip fractures treated with internal fixation heal. If nonunion or early loss of fracture fixation occurs, treatment options include prosthetic replacement and revision internal fixation. The purpose of the current study was to evaluate the results of revision internal fixation and bone grafting for salvage of failed internal fixation of intertrochanteric hip fractures. Between 1981 and 2000, 20 patients with 20 intertrochanteric fractures who had initial internal fixation that failed were treated with revision open reduction and internal fixation and bone grafting. The mean age of the patients was 58 years (range, 21-86 years). The mean clinical followup was 27 months (range, 3-120 months), and mean radiographic followup was 22 months (range, 3-120 months). Eleven patients were treated with an angled blade plate (seven, 95 degrees; two, 90 degrees; one, 110 degrees; and one, Harris blade plate), five with a dynamic hip screw, three with a dynamic condylar screw, and one with a Zickel nail. Autograft bone was used in 17 patients and allograft bone was used in three patients. Nineteen of 20 nonunions healed (95%). Sixteen of the 19 patients who achieved healing reported no pain and three had mild pain (related to retained hardware); all were ambulatory. Two patients had perioperative complications (10%): one wound dehiscence, and one severe hyponatremia. In properly selected patients, revision internal fixation with bone grafting for failed open reduction and internal fixation of intertrochanteric hip fractures can provide a high rate of union and good clinical results with a low rate of complications.

Adult↗
PubMed2003

Demographic factors affecting long-term outcome of total hip arthroplasty.

We report the outcome of total hip arthroplasty (THA) in a cohort of patients with complete long-term radiographic and clinical followup information from our database of more than 48,000 primary hip replacements. The purpose of the study was to evaluate the influence of various demographic factors and patient comorbidity (Charnley classification) on the long-term outcome of THA. The cohort was comprised of 25,990 total hip replacements (THRs) in 10,243 (46.6%) men and 11,754 (53.4%) women with a median age of 66 years (range, 20-96 years) at the time of arthroplasty. Our study confirmed that THA has an impressive efficiency and reliability in alleviating pain and improving function for almost all of the patients. Furthermore, the results are enduring with more than 90% of patients being satisfied with the outcome at 15 years. Clinical outcome measures reach their maximum at 2 to 5 years after arthroplasty and thereafter they decline gradually. Furthermore, patient age, gender, body mass index, and main diagnosis all have an influence on specific functional parameters. The Charnley classification has the most profound effect on the overall functional status of patients.

Adult↗
PubMed2003

Impacted cancellous graft plus cement in hip revision.

Revision of the femoral component is difficult in the presence of large cavitary defects of the femur. Impaction cancellous grafting used in conjunction with a cemented prosthesis has been recommended as a means of restoring bone stock while providing excellent and durable clinical results. Fifty-seven consecutive femoral revisions were done between 1993 and 1997 in 54 patients (24 men and 30 women) using the impaction grafting technique and a collarless, tapered, polished stem. Strut allografts were used for femoral reinforcement in 40 hips. No patient was lost to followup. One patient had an infection develop and had a resection arthroplasty. Three patients died of causes unrelated to the hip. After 6.3 years the clinical results were excellent. Radiographic evaluation showed no evidence of loosening in any of the 53 surviving hips. Subsidence of 1 to 3 mm was seen in 40 hips and subsidence of 4 to 6 mm was seen in two hips. Cancellous remodeling was observed in 42 hips. The most common complications were postoperative femoral fractures. All six fractures occurred at the distal end of the prosthesis, were not associated with prosthetic loosening, and were treated successfully with open reduction and internal fixation without prosthetic revision. These satisfactory results and the limited subsidence observed in our patients radiographs could be explained by the careful attention to the technical details of the procedure. However, even with the generous use of strut graft augmentation, postoperative femoral fractures remain our most serious complication.

Adult↗
PubMed2003

Treatment of Vancouver B3 periprosthetic femur fractures with a fluted tapered stem.

Periprosthetic femur fractures around a hip arthroplasty associated with a loose stem and severely deficient or comminuted bone typically have been treated with substitution for the proximal femur using an allograft prosthetic composite or a tumor prosthesis. Eight patients (mean age, 68 years; range, 34-80 years) with Vancouver Type B3 femur fractures were treated with revision using a long modular fluted tapered uncemented stem with retention of the proximal femur. Access to the failed prosthesis and joint was gained through the fracture or osteotomy and soft tissue attachments to the fracture fragments were maintained. One patient died within 1 week. The remaining patients were followed up 1 to 2 years (mean, 1.5 years). At final followup, all patients had stable implants and all acute fractures were healed. Marked reconstitution of proximal femoral bone stock was observed consistently. All surviving patients were ambulatory and none had more than mild pain. The preliminary results of this method show a high rate of stable implant fixation and fracture healing with preservation and reconstitution of the host femur.

Adult↗
PubMed2003

Hip arthroplasty for salvage of failed treatment of intertrochanteric hip fractures.

BACKGROUND: Failed treatment of an intertrochanteric fracture typically leads to profound functional disability and pain. Treatment with repeated attempts to gain union and to preserve the host femoral head usually is preferred for young patients, but salvage treatment with hip arthroplasty may be considered for selected older patients with poor bone quality, bone loss, or articular cartilage damage. The purpose of the present study was to evaluate the results and complications of hip arthroplasty performed as a salvage procedure after the failed treatment of an intertrochanteric hip fracture. METHODS: Between 1985 and 1997, sixty patients (forty-nine women and eleven men) with a mean age of seventy-eight years were treated at our institution with hip arthroplasty after the failed treatment of an intertrochanteric fracture. Thirty-two patients had a total hip arthroplasty with a cemented cup (twenty-four patients) or an uncemented cup (eight patients), twenty-seven had a bipolar hemiarthroplasty, and one had a unipolar hemiarthroplasty. A calcar-replacement design, extended-neck stem, or long-stem implant was used in fifty-one of the sixty hips. RESULTS: Ten patients died within two years (all with the implant intact), and six were lost to follow-up. The remaining forty-four patients were followed for a mean of five years (range, two to fifteen years). At the time of the last follow-up, thirty-nine patients had no or mild pain and five had moderate or severe pain; in all of these patients, the pain was in the region of the greater trochanter. Forty patients were able to walk, twenty-six with one-arm support or less. Twelve patients had a total of thirteen medical complications postoperatively. A total of five reoperations were performed: two patients had a revision, one had a rewiring procedure because of trochanteric avulsion, one had late removal of trochanteric hardware, and one had débridement of fat necrosis. One patient had two dislocations, both of which were treated with closed reduction. Kaplan-Meier survivorship analysis with revision of the implant for any reason as the end point revealed a survival rate of 100% at seven years and 87.5% (95% confidence interval, 67.3% to 100%) at ten years. CONCLUSIONS: Hip arthroplasty is an effective salvage procedure after the failed treatment of an intertrochanteric fracture in an older patient. Most patients have good pain relief and functional improvement. Calcar-replacement and long-stem implants often are required. Despite the operative challenges, surprisingly few serious orthopaedic complications were associated with this procedure in the present study.

Aged↗
PubMed2003

Cemented revision of failed uncemented femoral components of total hip arthroplasty.

BACKGROUND: The long-term results of revision of failed primary cemented femoral components with use of cement have been reported, but there is little information about the results of revision of failed uncemented femoral components with use of cement. The purpose of the present study was to examine the minimum five-year results for patients in whom a failed uncemented primary femoral component was revised with use of modern cementing techniques. METHODS: Forty-eight consecutive hips (forty-seven patients) in which a failed primary uncemented femoral component was revised with use of cement at one institution from 1985 to 1992 were followed prospectively and reviewed retrospectively. The mean age of the patients at the time of revision was sixty-seven years. Only seven revisions were performed with a long-stem femoral component. The postoperative cement mantle was classified, according to the system of Mulroy and Harris, as grade A in four hips, grade B in twenty-five, grade C1 in seven, grade C2 in twelve, and grade D in none. RESULTS: Eleven femoral components were removed or revised because of aseptic loosening (ten) or deep infection (one). An additional four unrevised femoral components had evidence of probable or definite loosening at the time of the final radiographic follow-up. Thus, fourteen (29%) of the forty-eight femoral implants demonstrated aseptic loosening during the study period. Five of the twenty-nine hips in which the postoperative cement mantle was classified as grade A or B had mechanical failure at the time of the final follow-up, compared with nine of the nineteen hips in which the postoperative cement mantle was classified as grade C1 or C2 (p < 0.05). Among the hips with surviving prostheses, 79% had had moderate or severe pain preoperatively whereas 25% had moderate or severe pain at the time of the final follow-up. The six-year rate of survival of the femoral component was 72% with revision for aseptic loosening as the end point and 67% with mechanical failure (revision for aseptic loosening or radiographic loosening) as the end point. CONCLUSIONS: While revision of a failed uncemented femoral implant with use of cement provided pain relief and improved function for most patients, the rate of loosening at the time of intermediate-term follow-up was higher than that commonly reported after revision of failed cemented implants with use of cement and also was higher than that commonly reported after revision with use of uncemented extensively porous-coated implants. Bone removal at the time of the initial implantation of the stem and bone loss due to subsequent failure of the uncemented implant often left little intramedullary cancellous bone, which may explain the high rate of loosening observed in the first decade after revision in this series.

Age Factors↗
PubMed2003

Treatment of periprosthetic femoral fractures following total hip arthroplasty with femoral component revision.

BACKGROUND: Revision total hip arthroplasty is indicated for most periprosthetic fractures that occur around the stem of the femoral implant. The purpose of the present study was to assess the results and complications of revision total hip arthroplasty for the treatment of periprosthetic femoral fractures. METHODS: We evaluated 118 hips in 116 patients who underwent revision total hip arthroplasty because of an acute Vancouver type-B periprosthetic femoral fracture. The femoral implant used for the revision was a cemented stem in forty-two hips, a proximally porous-coated uncemented stem in twenty-eight, an extensively porous-coated stem in thirty, and an allograft-prosthesis composite or tumor prosthesis in eighteen. The mean duration of follow-up was 5.4 years. RESULTS: Kaplan-Meier analysis demonstrated that the probability of survival was 90% at five years and 79.2% at ten years with revision or removal of the femoral implant for any reason as the end point. Sixteen femoral components were rerevised: ten were rerevised because of loosening; three, because of loosening in association with a fracture nonunion; two, because of recurrent dislocation; and one, because of a new periprosthetic fracture. Additionally, six femoral implants were resected because of deep infection (five) or prosthetic loosening (one). Radiographs of the ninety-six hips with a surviving implant showed that twenty-one had evidence of loosening of the femoral implant, four had a nonunion of the femoral fracture, and two had both a nonunion and loosening of the femoral implant. CONCLUSIONS: Revision total hip arthroplasty for the treatment of a periprosthetic fracture around the stem of the femoral implant successfully restored function for most patients. The greatest long-term problems were prosthetic loosening and fracture nonunion. Better results were seen when an uncemented, extensively porous-coated stem was used.

Adult↗
PubMed2003

Venous thromboembolism after a total hip arthroplasty: prevention and treatment.

The prevention and treatment of venous thromboembolic disease after total hip arthroplasty is a controversial issue that is important to orthopaedic surgeons and their patients. Important considerations include current risk factors, the efficacy and safety of preventive agents, the optimal duration of treatment with prophylaxis, the value of routine screening, and treatment recommendations after total hip arthroplasty.

Anticoagulants↗
PubMed2003

Removal of cementless stems.

Cementless femoral components may require removal because of loosening, thigh pain, infection, or hip instability. Methods to efficiently remove cementless implants of different designs and minimize bone loss have improved. Loose stems usually can be removed safely by clearing bone in the greater trochanteric region before removal. Well-fixed stems can be removed using cutting instruments to divide areas of bone ingrowth or ongrowth. When bone ingrowth involves the diaphyseal area, extended greater trochanteric osteotomies are especially effective in facilitating implant removal.

Arthroplasty, Replacement, Hip↗
PubMed2003

Osteonecrosis of the hip: management in the 21st century.

Osteonecrosis of the femoral head is a progressive condition that often leads to collapse of the femoral head. The ultimate goal in the treatment for osteonecrosis of the hip is preservation of the femoral head. However, the condition is difficult to treat because it is associated with a number of different diseases, and the etiology and natural history of the condition have not been definitively determined. The delineation of new information regarding the etiology, pathogenesis, and natural history of osteonecrosis is ongoing. Core decompression, vascularized and nonvascularized bone grafting procedures, and arthroplasty procedures play an important role in treatment.

Algorithms↗
PubMed2003

Treatment of supracondylar femur nonunions with open reduction and internal fixation.

We reviewed a consecutive series of 22 adults with 22 supracondylar femoral nonunions treated with open reduction and internal fixation (ORIF) to determine the results and complications associated with the procedure. Twenty-one of 22 nonunions (95%) healed. Knee Society pain scores improved from 18 to 88 (P < 0.001). Mean Knee Society functional scores improved from 4 to 55 (P < 0.001). Mean range of motion at follow-up was 1 degree to 96 degrees. ORIF and bone grafting of properly selected patients with nonunions of the distal femur resulted in high rate of union with few associated complications. All patients had improvement in pain scores and the great majority had improvements in functional scores.

Femoral Fractures↗
PubMed2002

Femoral revision: distal fixation with fluted, tapered grit-blasted stems.

Fluted, tapered grit-blasted titanium stems for revision total hip arthroplasty have been used extensively in Europe and have been reported to provide mostly favorable results. These stems are tapered to gain axial stability and fluted to gain rotational stability in the femoral diaphysis. Grit-blasted titanium provides a surface for bone ongrowth. Such implants can solve certain problems not addressed easily by other standard revision techniques. The clinical durability of modular implants, introduced to make these implants more user-friendly and more versatile, remains to be proved. These implants require special techniques for implantation, particularly when long-stemmed implants are used.

Arthroplasty, Replacement, Hip↗
PubMed2002

Management of periprosthetic fractures: the hip.

Treatment of periprosthetic fractures around a total hip arthroplasty is based on fracture timing (intraoperative or postoperative) and fracture location (acetabulum or femur). Most intraoperative fractures are treated by ensuring that the implant and fracture are stable and employing minor technique modifications to ensure that the fracture remains stable postoperatively. Major intraoperative fractures require more complex reconstruction. Postoperative fractures associated with well-fixed implants typically are treated with open reduction and internal fixation. Postoperative fractures associated with loose implants are treated with revision and fracture stabilization, usually with specialized revision implants.

Acetabulum↗
PubMed2002

Frequency of myocardial infarction, pulmonary embolism, deep venous thrombosis, and death following primary hip or knee arthroplasty.

BACKGROUND: There is limited information about the frequency of perioperative complications after elective primary orthopedic total hip and knee arthroplasty in contemporary practice. The purpose of this study was to determine the frequency of clinically relevant myocardial infarction, pulmonary embolism, deep venous thrombosis, and death within 30 days after elective primary hip or knee arthroplasty treated according to contemporary perioperative management. METHODS: The authors examined the medical records of consecutive patients undergoing hip or knee arthroplasty at their institution in a 10-yr period. Prospectively collected databases were used to identify patients with the diagnosis of myocardial infarction, pulmonary embolism, deep venous thrombosis, or death using strict validation criteria and diagnostic-certainty categories. RESULTS: A total of 10,244 patients underwent primary total hip or knee arthroplasty in the period of study. Of these, 224 patients had one or more adverse events (overall event rate: 2.2%; myocardial infarction: 0.4%; pulmonary embolism: 0.7%; deep venous thrombosis: 1.5%; death: 0.5%). Most adverse events (myocardial infarction, pulmonary embolism, and death) increased in frequency with older age, particularly for patients aged 70 yr or older. Myocardial infarction occurred more frequently in male patients. There were no differences in the overall event frequency between types of procedure. However, pulmonary embolism was highest in patients undergoing bilateral knee operations. CONCLUSIONS: The overall frequency of serious complications within 30 days after primary total hip or knee arthroplasty with contemporary practice was 2.2%. Accurate knowledge of the perioperative risks associated with widely performed elective operations can be used to implement management strategies that may further improve patient outcomes and decrease cost.

Adult↗
PubMed2002

Patellar component resection arthroplasty for the severely compromised patella.

When severe bone loss precludes reimplantation of a new patellar component during revision knee arthroplasty, the treatment options include patellar bone grafting, patellar component resection arthroplasty, and patellectomy. The purpose of this study was to evaluate the clinical and functional results of patellar component resection arthroplasty for the severely compromised patella for which insertion of another patellar component was not possible. Thirty-five knees (31 patients) were treated with patellar component resection arthroplasty for aseptic patellar component failure associated with severely compromised patellar bone stock. Followup averaged 7.9 years (range, 2-18 years). There was a significant improvement in Knee Society pain and function scores. Pain relief was more dramatic than functional improvement. The range of motion also improved significantly and in particular preoperative extensor lag was resolved in the majority of patients. Patients treated with isolated patellar resection arthroplasty were more likely to have continuing pain and require reoperation compared with patients who had concomitant revision of the tibial and femoral components. Correct positioning and the stability of tibial and femoral components should be tested carefully at the time of patellar resection arthroplasty and considered for revision if malpositioned either axially or rotationally.

Adult↗