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Donald S Garbuz

Publications and source records attributed to Donald S Garbuz.

At least 19 recordsLinked to original sources
PubMed2006

Delays worsen quality of life outcome of primary total hip arthroplasty.

Although there are indications of health status deterioration for patients while waiting for elective total hip arthroplasties, controversy exists regarding the effect of waiting on postoperative outcomes. We hypothesized that longer waiting times are detrimental to achieving the full benefit of surgery. We prospectively examined 201 patients with osteoarthritis who were on the waiting list for primary total hip arthroplasties. The Western Ontario and McMaster Universities Osteoarthritis Index questionnaire was used to assess patients at surgical consultation (preoperative) and 1 year postoperative. The study included regression models to determine the expected outcome for an individual's preoperative score. Logistic regression models were used to assess the relationship between waiting time and the probability of a better than expected outcome. We found that the odds of achieving a better than expected postoperative functional outcome decreased by 8% for each month on the waiting list. Expedited access resulted in a larger proportion of patients with better than expected function 12 months after surgery.

Adult↗
PubMed2005

Classifying health-related quality of life outcomes of total hip arthroplasty.

BACKGROUND: Primary total hip arthroplasty (THA) is an effective treatment for hip osteoarthritis, assessed by whatever distribution-based measures of responsiveness. Yet, the group level evaluation has provided very little evidence contributes to our understanding of the large variation of treatment outcome. The objective is to develop criteria that classify individual treatment health related quality of life (HRQOL) outcome after primary THA, adjusted by preoperative scores. METHODS: We prospectively measured 147 patients' disease specific HRQOL on the date of consultation and 12 months post operation by Western Ontario McMaster Universities Osteoarthritis Index (WOMAC). Regression models were used to determine the "expected" outcome for a certain individual baseline score. The ceiling effect of WOMAC measurement is addressed by implementing a left-censoring method. RESULTS: The classification criteria are chosen to be the lower boundary of the 95% confidence interval (CI) of the estimated median from the regression. The robustness of the classification criteria was demonstrated using the Monte-Carlo simulation. CONCLUSION: The classification criteria are robust and can be applied in general orthopaedic research when the sample size is reasonable large (over 500).

Aged↗
PubMed2005

Trochanteric osteotomies in revision total hip arthroplasty: contemporary techniques and results.

Revision total hip arthroplasty (THA) presents several challenges to the orthopaedic surgeon and typically requires the use of a more extensile surgical approach. Osteotomy of the greater trochanter can be considered as the ultimate extensile exposure in revision THA. The methods of trochanteric osteotomy can be categorized into three types: the standard trochanteric osteotomy, the trochanteric slide, and the extended trochanteric osteotomy. Although the standard osteotomy and trochanteric slide osteotomy provide excellent acetabular exposure, in the revision setting they are frequently associated with an unacceptably high rate of nonunion and proximal migration of the trochanteric fragment. The extended trochanteric osteotomy (ETO) has increased in popularity as the number and complexity of revision THAs continue to increase. Two commonly used techniques are the ETO via a posterolateral approach or via a modified direct lateral approach. Both techniques provide wide exposure of the acetabulum, facilitate femoral component exposure and removal, aid in canal preparation and femoral reconstruction, and allow for correction of proximal femoral deformity. The osteotomy fragment is easily secured and may be advanced distally to achieve proper tensioning of the abductors. Recent literature demonstrates that the ETO has a relatively low rate of nonunion and is associated with fewer intraoperative femoral fractures or cortical perforations, as well as decreased surgical time.

Arthroplasty, Replacement, Hip↗
PubMed2004

Patient satisfaction and functional status after aseptic versus septic revision total knee arthroplasty using the PROSTALAC articulating spacer.

This study compared the functional results of an articulating antibiotic spacer for 2-stage revision knee arthroplasty for infection, to the functional results of aseptic revision. One hundred twenty-five patients who underwent revision of total knee arthroplasty for infection and aseptic loosening were identified. All of the patients with infection were treated with the PROSTALAC system (DePuy). At a minimum 2-year follow-up, WOMAC, Oxford-12, SF-12, patient satisfaction data, Harris Hip Score knee scores, and range of motion were assessed. The 2 cohorts (4 deaths in total, leaving 54 septic, 57 aseptic) were equivalent for age, gender, and comorbidity scores. At a mean of 41 months, none of the outcomes were significantly worse for the septic group, which had 2 recurrences of infection (4%). The satisfactory functional results of the PROSTALAC system may be related to the design features.

Anti-Bacterial Agents↗
PubMed2004

Minimally invasive hip replacement: rationale, applied anatomy, and instrumentation.

The term minimally invasive hip replacement encompasses a diverse range of surgical approaches through which hip replacement may be performed. These surgical approaches are technically demanding and are best performed using specially designed instruments that help to compensate for the reduced surgical exposure. The early results using these techniques are encouraging, although the literature is lacking evidence from well designed prospective trials comparing MIS techniques with standard approaches. The studies that exist suggest that patient satisfaction is high, bleeding may be reduced, recovery of function may be faster, and there may be the potential to reduce lengths of hospital stay, and all this may be achieved without increasing complication rates. These results,however, have been achieved by a small number of high-volume surgeons, and the authors feel it is essential that as these techniques are introduced into widespread practice the results be studied carefully.

Arthroplasty, Replacement, Hip↗
PubMed2004

Intraoperative fracture of the femur in revision total hip arthroplasty with a diaphyseal fitting stem.

BACKGROUND: In revision total hip arthroplasty, intraoperative split fractures and cortical perforation fractures are becoming a more common concern with the increasing use of diaphyseal fitting cementless stems. The purpose of this study was to evaluate the risk factors and frequency of intraoperative fractures with the use of these stems and their effect on radiographic and functional outcomes. METHODS: We performed a retrospective case-control study of 211 consecutive patients who had undergone revision hip arthroplasty with a diaphyseal fitting cementless stem between December 1998 and March 2002. Sixty-four patients sustained an intraoperative fracture of the femur. One hundred and fifteen patients were followed for a minimum of two years; function was analyzed with self-administered outcome questionnaires, and radiographs were evaluated for evidence of bone ingrowth into the femoral stem. RESULTS: Risk factors associated with an intraoperative fracture were a substantial degree of preoperative bone loss, a low femoral cortex-to-canal ratio, underreaming of the cortex, and the use of a large-diameter stem. The majority of the diaphyseal undisplaced linear fractures occurred at the distal end of an extended trochanteric osteotomy during stem insertion. Fracture due to cortical perforation occurred most often during cement removal. These intraoperative fractures had no significant effect on the functional outcome or radiographic evidence of bone ingrowth. CONCLUSIONS: There was a surprisingly high rate of intraoperative femoral fractures associated with the use of a diaphyseal fitting stem in revision total hip arthroplasty. Identification of risk factors such as preoperative bone loss and a low cortex-to-canal ratio may permit planning to avoid such fractures. However, the final functional and radiographic outcomes appear to have been unaffected by the fracture when it had been managed appropriately. LEVEL OF EVIDENCE: Prognostic study, Level II-1 (retrospective cohort study). See Instructions to Authors for a complete description of levels of evidence.

Activities of Daily Living↗
PubMed2004

Cable plates and onlay allografts in periprosthetic femoral fractures after hip replacement: laboratory and clinical observations.

Fractures of the femur after total hip replacement are an increasingly common and technically challenging problem. The results of nonsurgical treatment are poor. When the general condition of the patient allows, these injuries should be treated surgically. Several surgical treatments can be used to treat these fractures, and classification of the fracture assists the surgeon in the choice of procedure. Over the past decade, cable plate fixation systems and onlay strut allografts have become two of the most commonly used methods of fixation for fractures associated with hip prostheses. The ideal method of fixation is yet to be determined. However, laboratory studies have shown that dual fixation using either a lateral plate and anterior strut graft or two strut grafts produces the strongest construct. Cables rather than smooth wires should be used for fixation, and fixation strength increases with the number of cables used. The use of screws proximally produces a strong fixation but there are theoretical disadvantages to using screws around a femoral implant. Clinical data show high rates of fracture union using cable plate fixation, cortical onlay allograft fixation, and combined fixation methods for fractures that occur around well-fixed implants. Results have been less encouraging when these techniques have been used to fix fractures around prostheses that are either loose or malaligned; such fractures are better managed by revision of the femoral component to a long-stemmed device. Care should also be taken when there has been previous periosteal stripping of the femur because this may predispose to fracture nonunion. Periprosthetic fractures of the femur are a complex surgical problem and require specialized training in a range of surgical techniques.

Arthroplasty, Replacement, Hip↗
PubMed2004

Extended trochanteric osteotomy: planning, surgical technique, and pitfalls.

The extended trochanteric osteotomy is appropriate for a number of surgical indications. It facilitates removal of well-fixed cement mantles with a loose or well-fixed stem and of extensively porous-coated or tapered cementless stems. This exposure is particularly valuable in the presence of varus remodeling of the proximal femur, permitting correction of proximal femoral deformity and reducing the risk of fracture of the greater trochanter. It is also indicated in the removal of a well-fixed cemented stem that is complicated by infection, where it is vital to extract all foreign material for successful eradication of the infection. In addition, when the osteotomy is required for femoral exposure, it enhances acetabular exposure to allow even the most complex reconstruction. Also, as the soft-tissue attachments to the bone fragment are preserved in this approach, abductor muscle tension can be adjusted.

Arthroplasty, Replacement, Hip↗
PubMed2004

Cementing constrained acetabular liners in revision hip replacement: clinical and laboratory observations.

During revision hip arthroplasty, removal of a well-fixed, ingrown metal acetabular component may not be possible. Therefore, a new polyethylene liner can be cemented into the existing shell via the cement locking mechanism. This technique is well recognized, and the cement locking mechanism has proved to be sufficiently strong and durable for clinical use. A constrained polyethylene liner is designed to reduce the risk of hip dislocation by capturing the femoral head. However, there are increased shear forces created at the liner interface as the dislocation is resisted. If a constrained liner is cemented into an ingrown acetabular component, then there is the theoretical risk that these increased shear forces will damage the cement locking mechanism, thus leading to failure of the construct. There are a few clinical series in which a constrained liner has been used with the cement locking mechanism. Overall, the failure rate of the cement locking mechanism is no greater if a constrained liner instead of a standard liner is used. The cement locking mechanism can be strengthened by roughening the backside of a smooth polyethylene liner to improve the cement-polyethylene interface, or by using an all-polyethylene acetabular component that is designed to be used with cement. Whether a smooth metal shell needs to be roughened as well is a matter of debate.

Arthroplasty, Replacement, Hip↗
PubMed2004

Can a new design of pneumatic compression device reduce variations in delivered therapy for the mechanical prophylaxis of thromboembolic disease after total hip arthroplasty?

BACKGROUND: Compression devices have been shown to prevent thromboembolic disease. However, the pressures generated may not be the same as the ones recommended by the manufacturer. The purpose of this study is to investigate a new sequential compression device with feedback to maintain optimal therapy, and to determine whether therapy is improved with this new device. PATIENTS AND METHOD: A series of 50 patients undergoing elective total hip arthroplasty at a major tertiary-care hospital with a special interest in joint replacement were enrolled prospectively. In addition to pharmacological prophylaxis for thromboembolic disease, all patients received compression from a modified device. Maximum pressures generated and the rate of pressure rise in each of the 3 compartments within the device sleeves were measured and the results compared with data from historical controls. RESULTS: We considered therapy to be ideal when in a particular compression cycle all chambers of both right and left sleeves reach within 10% of their target pressures at within 10% of their target pressure rise rates. The average patient received this ideal therapy 88% of the time that the new trial sequential compression device was operating. This represents a dramatic improvement over previous devices. CONCLUSIONS: The new device allows dramatically improved pressures within the device because of a feedback loop that allows dynamic control of each chamber's pressure. Improved consistency of delivery should make it easier to accurately assess the true benefits of mechanical prophylaxis with a sequential compression device.

Adult↗
PubMed2003

Patient satisfaction and functional status after treatment of infection at the site of a total knee arthroplasty with use of the PROSTALAC articulating spacer.

BACKGROUND: Two-stage exchange arthroplasty remains the standard treatment of infection at the site of a total knee arthroplasty. The clinical and functional outcomes associated with the use of an articulating antibiotic spacer for two-stage revision for infection are not well established. We conducted a retrospective study to evaluate the outcomes associated with the use of the PROSTALAC articulating spacer between the first and second stages. METHODS: Fifty-eight patients underwent two-stage revision total knee arthroplasty for infection between January 1997 and December 1999. Of these, fifty-four were alive at the time of follow-up and forty-seven were available for inclusion in the present retrospective study. In all patients, a prosthesis of antibiotic-loaded acrylic cement (the PROSTALAC system) was implanted during the first stage after débridement. The amount of osteolysis that occurred between the stages and the range of motion of the knee joint were measured. After two years of follow-up, outcomes were assessed with use of the WOMAC, Oxford-12, and SF-12 instruments as well as a satisfaction questionnaire. RESULTS: At a minimum of two years (average, forty-one months) after revision arthroplasty, two patients (4%) had had a recurrence of infection. The amount of bone loss was unchanged between stages, and the range of movement of the knee improved from 78.2 degrees before the first stage to 87.1 degrees at two years. The average normalized WOMAC function and pain scores were 68.9 and 77.1, respectively; the average Oxford-12 score was 67.3; the average SF-12 mental and physical scores were 53.7 and 41.2, respectively; and the average satisfaction score was 71.7. CONCLUSION: A revision operation for infection at the site of a total knee replacement with use of an articulating spacer was associated with reasonable function and satisfaction scores. These findings may be related to the articulating features of the PROSTALAC system, which permits full active movement of the knee in the early postoperative period.

Anti-Bacterial Agents↗
PubMed2003

The prevention of periprosthetic fractures of the femur during and after total hip arthroplasty.

The increasing prevalence of periprosthetic fractures of the femur associated with total hip arthroplasty (THA) is caused by several factors, including the increasing use of cementless prostheses in both primary and revision procedure, the rise in THAs in younger patients, who are more at risk of high-energy trauma, and the increasing longevity of elderly patients after THA. With approximately 200,000 THAs performed annually in North America, fracture prevention is extremely important for the individual patient and has a significant impact on the health care system.

Arthroplasty, Replacement, Hip↗
PubMed2003

Principles of management and results of treating the fractured femur during and after total hip arthroplasty.

The management of fractures of the femur during and after total hip arthroplasty can be difficult, and treatment can be fraught with complications. The ideal scenario would be one in which these fractures are prevented. It is important that the surgeon has a through understanding of the principles of managing these fractures and has access to a variety of fixation and prosthetic devices and allograft bone when necessary in order to provide the best treatment. Because periprosthetic fractures range from the very simple (requiring no surgical intervention) to the complex (requiring major revision), a classification system of these fractures aids in understanding both the principles of management and results of treatment.

Arthroplasty, Replacement, Hip↗
PubMed2003

Cementless revision for infection following total hip arthroplasty.

Eradication of chronic infection complicating total hip arthroplasty requires removal of all infected, devitalized and foreign tissue, including the arthroplasty components. Reimplantation into a sterile bed is the goal of treatment in most patients and successful reimplantation yields better functional results than excision arthroplasty. Reimplantation may be performed at the same stage as débridement as part of a single-stage procedure, using cemented components with antibiotic-loaded cement. Alternatively, a two-stage procedure may be performed so that the débridement and reimplantation are separated by a period of antibiotic delivery, both locally and systemically. The results of these treatment regimens and the rationale for cementless reconstruction at the second stage of a two-stage treatment protocol are important considerations in the treatment of periprosthetic infection.

Anti-Bacterial Agents↗
PubMedDate not supplied

Computer-assisted femoral head resurfacing.

Femoral head resurfacing is re-emerging as a surgical option for younger patients who are not yet candidates for total hip replacement. However, this procedure is more difficult than total hip replacement, and the mechanical jigs typically used to align the implant produce significant variability in implant placement and take a significant amount of time to position properly. We propose that a computer-assisted surgical (CAS) technique could reduce implant variability with little or no increase in operative time. We describe a new CAS technique for this procedure and demonstrate in a cadaver study of five paired femurs that the CAS technique in the hands of a novice surgeon markedly reduced the varus/valgus variability of the implant relative to the pre-operative plan (2 degrees standard deviation for CAS versus 5 degrees for a mechanical jig operated by an expert surgeon). We also show that the mechanical jig resulted in significantly retroverted implant placement. There was no significant difference in operative time between the two techniques.

Arthroplasty, Replacement, Hip↗
PubMedDate not supplied

Evaluation of pain in patients with apparently solidly fixed total hip arthroplasty components.

The cause of pain in a patient with an apparently solidly fixed total hip arthroplasty can be difficult to elucidate. A detailed history, careful examination, and plain radiographs provide the most useful information, especially in excluding causes not primarily related to the hip. Determining whether the pain is related to the implant, to soft tissue, or to bone can require laboratory tests, radiographic and fluoroscopic imaging, and contrast arthrography and local anesthetic injections. Particularly when pain is caused by occult infection, erythrocyte sedimentation rate, C-reactive protein level, hip aspiration, advanced radiologic imaging, and nuclear medicine scans can help determine the diagnosis.

Arthroplasty, Replacement, Hip↗