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Daniel J Berry

Publications and source records attributed to Daniel J Berry.

67 records · Page 4Linked to original sources
PubMed2002

Long-term survivorship of cemented bipolar hemiarthroplasty for fracture of the femoral neck.

Cemented bipolar hemiarthroplasty commonly is used to treat displaced fractures of the femoral neck in elderly patients. The purpose of the current study was to review the results and survivorship of 212 bipolar hemiarthroplasties done in 205 patients for acute femoral neck fracture between 1976 and 1985. The mean age of the patients at the time of surgery was 79 years (range, 61-100 years). The mean followup for the patients who were alive was 11.7 years (range, 5.3-16.8 years) and 5.8 years (range, 51 days-19.4 years) for the entire group. Ten hips (4.7%) were revised or removed: five for aseptic femoral component loosening, one for acetabular erosion, one for chronic dislocation, and three for infection. In living patients with surviving implants, 96.2% had no or slight pain. Ten-year survivorship free of reoperation for any reason was 93.6%, free of revision surgery for aseptic femoral loosening or acetabular cartilage wear was 95.9%, free of revision surgery for aseptic femoral loosening was 96.5%, and free of revision surgery for acetabular cartilage wear was 99.4%. Cemented bipolar hemiarthroplasty for acute femoral neck fracture is associated with excellent component survivorship in elderly patients. The rate of complications was low, and the arthroplasty provided satisfactory pain relief for the lifetime of the majority of elderly patients.

Age Factors↗
PubMed2002

Uncemented acetabular components for arthritis after acetabular fracture.

The purpose of the current study was to evaluate the results of uncemented acetabular components used to treat posttraumatic arthritis after acetabular fracture at a minimum of 10 years. Thirty-four hips in 33 patients (mean age, 49.7 years, range, 19-78 years) were treated from 1984 to 1990 at one institution with a total hip arthroplasty using an uncemented titanium porous-coated socket. Four patients died before 10 years (all with implants intact). Nine patients had the acetabulum revised: four had the shell and liner revised (one for loosening, one for loosening and dislocation, and two for osteolysis) and five had the liner alone revised (three for polyethylene wear and two for dislocation). All patients with unrevised hip replacements who were alive and patients who were not lost to followup had no or minimal pain at final followup (range, 10-16 years); no components were radiographically loose. Uncemented sockets had a low rate of loosening in this challenging patient population, but polyethylene wear and osteolysis were problematic.

Acetabulum↗
PubMed2002

Twenty-five-year survivorship of two thousand consecutive primary Charnley total hip replacements: factors affecting survivorship of acetabular and femoral components.

BACKGROUND: Charnley total hip arthroplasty has been demonstrated to provide good clinical results and a high rate of implant survivorship for twenty years and longer. Most long-term series are not large enough to stratify the many demographic factors that influence implant survivorship. The purpose of this study was to analyze the effects of demographic factors and diagnoses on the long-term survivorship of the acetabular and femoral components used in Charnley total hip arthroplasty. METHODS: Two thousand primary Charnley total hip arthroplasties (1689 patients) were performed at one institution from 1969 to 1971. Patients were contacted at five-year intervals after the arthroplasty. Twenty-five years after the surgery, 1228 patients had died and 461 patients were living. Hips that had not had a reoperation, revision or removal of a component for any reason, or revision or removal for aseptic loosening were considered to have survived. Survivorship data were calculated with use of the method of Kaplan and Meier. Patients were stratified by age, gender, and underlying diagnosis to determine the influence of these factors on implant survivorship. RESULTS: The twenty-five year rates of survivorship free of reoperation, free of revision or removal of the implant for any reason, and free of revision or removal for aseptic loosening were 77.5%, 80.9% and 86.5%, respectively. The twenty-five-year survivorship free of revision for aseptic loosening was poorer for each decade earlier in life at which the procedure was performed; this survivorship ranged from 68.7% for patients who were less than forty years of age to 100% for patients who were eighty years of age or older. Men had a twofold higher rate of revision for aseptic loosening than did women. CONCLUSIONS: Age, gender, and underlying diagnosis all affected the likelihood of long-term survivorship of the acetabular and femoral components used in Charnley total hip arthroplasty.

Acetabulum↗
PubMed2002

Patellar fracture after total knee arthroplasty.

BACKGROUND: Patellar fracture can occur as a complication following total knee arthroplasty. The purpose of this study was to evaluate a large series of patellar fractures to determine the results of different forms of treatment of specific fracture types. METHODS: A retrospective review identified eighty-five fractures (in seventy-seven patients) following 12,464 consecutive total knee arthroplasties performed between 1985 and 1998. Seventy-eight fractures occurred after primary total knee arthroplasty and seven, after revision total knee arthroplasty. Five fractures were treated elsewhere, and two others were lost to follow-up. The results of treatment of the remaining seventy-eight fractures were reviewed. Fractures were classified according to three main criteria: integrity of the extensor mechanism, fixation status of the patellar implant, and quality of the remaining bone stock. The mean duration of follow-up was 3.6 years. RESULTS: The prevalence of patellar fracture after total knee arthroplasty was 0.68%; fractures were significantly more prevalent among men (1.01%) than among women (0.40%) (p = 0.0004). Thirty-eight fractured patellae had a stable implant and an intact extensor mechanism (Type I). All but one were treated nonoperatively, and there was only one late failure of nonoperative treatment, which required operative intervention. Twelve fractures were associated with disruption of the extensor mechanism (Type II). Eleven were treated operatively; six knees had complications and five had a reoperation. Twenty-eight fractures occurred in association with a loose patellar component (Type III). Twenty were treated operatively; nine knees had complications, and four had a reoperation. CONCLUSIONS: Patellar fractures after total knee arthroplasty are infrequent. Treatment can be guided by three main criteria: integrity of the extensor mechanism, fixation status of the patellar implant, and quality of the remaining bone. Fractures associated with a stable implant and an intact extensor mechanism were usually treated successfully with nonoperative means, with minimal complications. When operative treatment was required, it was associated with a high rate of complications and reoperations.

Adult↗
PubMed2002

Magnetic resonance imaging pelvimetry before and after a periacetabular osteotomy.

BACKGROUND: The majority of patients who undergo a reconstructive pelvic osteotomy because of symptomatic hip dysplasia are young women of childbearing potential. The purpose of this paper was to evaluate the effect of periacetabular osteotomy on the dimensions of the pelvic inlet and outlet in these patients. METHODS: The dimensions of the osseous pelvis of seven women with symptomatic hip dysplasia were measured with use of magnetic resonance imaging pelvimetry before and after periacetabular osteotomy. Four measurements were made: the bispinous diameter, the anterior-posterior inlet measurement, the anterior-posterior midpelvis measurement, and the transverse inlet measurement. Radiographic correction obtained with the osteotomy was documented with preoperative and postoperative anteroposterior pelvic and false-profile radiographs. RESULTS: Periacetabular osteotomy improved the T nnis angle and the Lequesne angle of the hip joint to an average of 8 degrees and 30 degrees, respectively. The hip center of rotation was medialized an average of 8 mm. None of the four measurements made with the magnetic resonance imaging pelvimetry decreased substantially after the periacetabular osteotomy. CONCLUSION: Periacetabular osteotomy does not markedly alter the pertinent pelvic dimensions in young female patients.

Acetabulum↗
PubMed2002

Long-term results of use of a collared matte-finished femoral component fixed with second-generation cementing techniques. A fifteen-year-median follow-up study.

BACKGROUND: So-called second-generation cementing techniques in total hip arthroplasty have been shown to provide better survival of the femoral component than first-generation methods do; however, surface finish and other features of the component design also influence the durability of the reconstruction. The purpose of this study was to determine the results of primary total hip replacement with use of a collared femoral component with a matte-finished surface fixed with second-generation cementing techniques and followed for ten to twenty years. METHODS: The study group consisted of 256 consecutive hips in 236 patients who had had a primary total hip arthroplasty with fixation of a Harris Design-2 femoral component with second-generation cementing techniques (use of an intramedullary plug and a cement gun). The mean age of the patients at the time of the operation was sixty-six years. One hundred and twelve patients were male, and 124 were female. Seven patients were lost to follow-up less than ten years after the operation. The median duration of follow-up of the living patients who had not had a revision was 15.4 years. RESULTS: At the time of the most recent follow-up, nineteen femoral components (7%) had been revised because of aseptic loosening, five (2%) had been removed because of deep infection, and one (0.4%) had been revised because of recurrent dislocation. The mean Harris hip score for the surviving patients who had not had a revision improved from 51 points preoperatively to 91 points at the most recent evaluation. At fifteen years, the estimated survival rate of the femoral components was 92.2% with revision due to aseptic loosening as the end point and 90.1% with mechanical failure (radiographic loosening or revision due to aseptic loosening) as the end point. Patients who were younger than fifty years old at the time of the operation had a lower fifteen-year rate of survival of the femoral implant, in terms of both revision due to aseptic loosening (72.3% compared with 95.7%, p = 0.0001) and mechanical failure (72.3% compared with 93.1%, p = 0.005), than did patients who were fifty years or older. CONCLUSIONS: Fixation of this collared matte-finished femoral component with use of second-generation cementing techniques for primary total hip replacement provided satisfactory results at ten to twenty years in older patients but less satisfactory results in younger patients.

Adolescent↗
PubMed2002

Late dislocation after total hip arthroplasty.

BACKGROUND: Some patients have a dislocation for the first time many years after a total hip arthroplasty, but little is known about the risk factors and outcomes associated with late dislocation. The purposes of this study were (1) to determine the prevalence of late dislocation after total hip arthroplasty, (2) to characterize demographic and other factors associated with such late dislocations, and (3) to report the outcomes of such late dislocations. METHODS: Between 1969 and 1995, 19,680 primary total hip arthroplasties were performed in 15,964 patients at our institution. According to a prospective surveillance protocol, the patients were followed routinely at regular intervals and were specifically queried at each time-point about whether (and, if so, when) the hip had dislocated. First dislocations that occurred five years or more after the operation were defined as late dislocations. RESULTS: Five hundred and thirteen (2.6%) of the 19,680 hips dislocated. Of the 513 hips, 165 (0.8% of the entire cohort; 32% of the dislocated hips) first dislocated five or more years after the primary arthroplasty. The median time until the occurrence of these late dislocations was 11.3 years (range, five to 24.9 years) after the operation. Late dislocation was more frequent than early dislocation in women (p = 0.03), and late dislocation was associated with a younger age at the time of the primary total hip arthroplasty (median, sixty-three years) than was early dislocation (median, sixty-seven years) (p = 0.02). Clinical factors associated with late dislocation included previous subluxations without dislocation in twenty patients, a substantial episode of trauma in eleven patients, and onset of marked cognitive or motor neurologic impairment in eleven patients. Radiographically, the late dislocation occurred in association with polyethylene wear of >2 mm in eighteen hips, with implant loosening with migration or a change in position in eight, and with initial malposition of the acetabular implant (anteversion of <0 degrees or >30 degrees or abduction of >55 degrees) in thirty. Late dislocation recurred in ninety (55%) of the 165 hips and was treated with a reoperation in fifty-five hips (33% of the hips with late dislocation; 61% of the hips with recurrent dislocation). CONCLUSIONS: Late dislocation is more common than was previously thought. Several separate processes, some distinct from those associated with early dislocation, can lead to late dislocation. Late dislocation can occur in association with a long-standing problem with the prosthesis that manifests late (such as malposition of the implant or recurrent subluxation), it can occur in association with a new problem (such as neurologic decline, an episode of trauma, or polyethylene wear), or it can occur in association with any combination of these factors. The likelihood of the first late dislocation recurring is high.

Adolescent↗
PubMed2002

Septic arthritis due to Streptococcus sanguis.

We report an unusual case of septic arthritis due to Streptococcus sanguis, a member of the viridans group of streptococci that are part of the normal flora of the mouth and upper respiratory tract. Our patient had severe underlying periodontal disease, which likely contributed to his joint sepsis through hematogenous spread. Although viridans streptococci are rare causes of septic arthritis in native joints, they should be considered in the setting of severe periodontal disease.

Aged↗
PubMed2002

Periprosthetic femoral fractures around well-fixed implants: use of cortical onlay allografts with or without a plate.

BACKGROUND: Periprosthetic femoral fractures around hip replacements are increasingly common. When the femoral component is stable, open reduction and internal fixation is recommended in all but exceptional cases. The purpose of this study was to evaluate the outcome of treatment of fractures around stable implants with cortical onlay strut allografts with or without a plate. METHODS: A survey of our four centers identified forty patients with a fracture around a well-fixed femoral stem treated with cortical onlay strut allografts without revision of the femoral component. There were fourteen men and twenty-six women, with an average age of sixty-nine years. Nineteen patients were treated with cortical onlay strut allografts alone, and twenty-one were managed with a plate and one or two cortical struts. All of the patients were followed until fracture union or until a reoperation was done. The mean duration of follow-up was twenty-eight months for thirty-nine patients. One patient, who was noncompliant with treatment recommendations, had a failure at two months because of a fracture of the plate and graft. The primary end point of the evaluation was fracture union; secondary end points included strut-to-host bone union, the amount of final bone stock, and postoperative function. RESULTS: Thirty-nine (98%) of the forty fractures united, and strut-to-host bone union was typically seen within the first year. There were four malunions, all of which had <10 degrees of malalignment, and one deep infection. There was no evidence of femoral loosening in any patient. All but one of the surviving patients returned to their preoperative functional level within one year. CONCLUSIONS: Cortical onlay strut allografts act as biological bone plates, serving both a mechanical and a biological function. The use of cortical struts, either alone or in conjunction with a plate, led to a very high rate of fracture union, satisfactory alignment, and an increase in femoral bone stock at the time of short-term follow-up. Although this study did not address the potential for later allograft remodeling, our findings suggest that cortical strut grafts should be used routinely to augment fixation and healing of a periprosthetic femoral fracture.

Aged↗
PubMedDate not supplied

Surgical treatment of developmental dysplasia of the hip in adults: I. Nonarthroplasty options.

Hip dysplasia is a developmental disorder that results in anatomic abnormalities leading to increased contact pressure in the joint and, eventually, coxarthrosis. However, many patients with hip dysplasia become symptomatic before the development of severe degenerative changes because of abnormal hip biomechanics, mild hip instability, impingement, or associated labral pathology. Several nonarthroplasty treatment options are available. Because the primary deformity is mostly acetabular, for many patients, a reconstructive osteotomy that restores more nearly normal pelvic anatomy is preferable. The Bernese periacetabular osteotomy is presently favored because it provides good correction while creating little secondary pelvic deformity or destabilizing the pelvis. Proximal femoral osteotomy is occasionally needed as a complement to pelvic osteotomy and may also be indicated as an isolated procedure when most deformity is located on the femoral side (coxa valga subluxans). Arthroscopy can be beneficial when symptoms seem to be related only to labral tears or loose bodies in the absence of severe structural abnormalities about the hip. Fusion and resection arthroplasty are rarely indicated and are reserved for occasional patients who are not candidates for total hip replacement or other procedures but who complain of refractory hip pain.

Acetabulum↗
PubMedDate not supplied

Surgical treatment of developmental dysplasia of the hip in adults: II. Arthroplasty options.

Total hip arthroplasty is the procedure of choice for most patients with symptomatic end-stage coxarthrosis secondary to hip dysplasia. The anatomic abnormalities associated with the dysplastic hip increase the complexity of hip arthroplasty. When pelvic bone stock allows, it is desirable to reconstruct the socket at or near the normal anatomic acetabular location. To obtain sufficient bony coverage of the acetabular component, the socket can be medialized or elevated, or a lateral bone graft can be applied. Uncemented acetabular components allow biologic fixation with potentially improved results compared with cemented cups, especially in young patients. The location of the acetabular reconstruction and the desired leg length influence the type of femoral reconstruction. Cemented and uncemented implants can be used in femoral reconstruction, depending on the clinical situation. Femoral shortening is required in some cases and can be performed by metaphyseal resection with a greater trochanteric osteotomy and advancement or by a shortening subtrochanteric osteotomy. The results of total hip arthroplasty demonstrate a high rate of pain relief and functional improvement. The long-term durability of cemented total hip arthroplasty reconstruction in these patients is inferior to that in the general population. The results of uncemented implants are promising, but only limited early and midterm data are available.

Acetabulum↗
PubMedDate not supplied

Salvage of failed treatment of hip fractures.

Typically, patients with failed internal fixation of a hip fracture have marked pain and disability. These patients may present treatment challenges. Salvage is tailored to the anatomic site of the nonunion, the quality of the remaining bone and articular surface, and patient factors such as age and activity level. In younger patients with either a femoral neck or intertrochanteric fracture nonunion with a satisfactory hip joint, treatment typically involves revision internal fixation with or without osteotomy or bone grafting. In older patients with poor remaining proximal bone stock or a badly damaged hip joint, conversion to hip arthroplasty can restore function effectively and reduce pain. For femoral head salvage procedures, choosing a fixation device and accurate preoperative planning are the major challenges in decision making. For conversion to arthroplasty, the major challenges are assessing the need for acetabular resurfacing, selecting the femoral implant, and managing the greater trochanter. Technical challenges include broken hardware, deformity, and femoral bone defects. Attention to technical details can minimize potential complications.

Age Factors↗