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Biomedical subjects

E L Masterson

Publications and source records attributed to E L Masterson.

14 recordsLinked to original sources
PubMed1999

Impaction allografting of the proximal femur using a Charnley-type stem: a cement mantle analysis.

The preoperative and early postoperative radiographs of 50 patients undergoing femoral impaction grafting with a modified Charnley stem and dedicated impaction grafting instrumentation were assessed to determine the predictability of the cement mantle being produced. The minimal cement mantle thickness was >2 mm in 76.7%, <2 mm in 12.7%, and absent in 10.7% of Gruen zones analyzed. There was no obvious zonal distribution to the areas of adequate or inadequate cement thickness. These values compare favorably with the results of other systems, and this may be due, in part, to a greater differential between the size of the graft impactors and the definitive prostheses.

Adult↗
PubMed1998

The classification and radiographic evaluation of bone loss in revision hip arthroplasty.

Many classification systems have been described over the past 10 years for bone loss that is found in association with the failed hip arthroplasty. Most are based on assessments of bone stock that are made intraoperatively. Good-quality plain radiography is the most useful preoperative investigation and provides important information regarding the residual bone stock. There is a need for critical appraisal of the validity of classification systems currently in use and the development of a consensus system that will permit comparison between the published results of different techniques.

Acetabulum↗
PubMed1998

Impaction allografting with cement for the management of femoral bone loss.

Impaction allografting with cement is the only technique currently available which reverses the diminution of bone stock that occurs in a revision hip arthroplasty, and as such, has great potential. It is particularly appropriate in the younger patient, though older patients may also benefit from the technique. Although the short term results are encouraging, there is a need for further basic science research to determine the optimal graft material and prosthesis design. Refinements in surgical instrumentation and technique will continue to improve the predictability of the clinical result and expand the indications for this important addition to the available options in revision hip arthroplasty.

Age Factors↗
PubMed1998

Distal ulnar tumours. Results of management by en bloc resection in nine patients and review of the literature.

A variety of reconstructive procedures have been suggested for stabilizing the ulnar shaft following resection of the distal ulna for tumour. We present the results of a series of nine distal ulnar tumour resections in which four different stabilization techniques were employed. We based our results on an evaluation of function, pain, motion, strength and instability. We obtained good or excellent results in seven patients treated with a soft tissue stabilization of the ulnar stump. One patient did not undergo any stabilization procedure and scored fair in our system. A further patient who required a radiocarpal arthrodesis also had an inferior result. These results suggest that soft tissue stabilization of the ulnar stump should be performed whenever possible.

Adult↗
PubMed1998

Capsular replacement with synthetic mesh: effectiveness in preventing postoperative dislocation after wide resection of proximal femoral tumors and prosthetic reconstruction.

We describe a surgical technique for replacing the hip joint capsule using synthetic mesh after oncological resections of the proximal femur that resulted in gross intraoperative instability of the prosthetic reconstruction. The results of its use in 13 patients, 6 of whom also had pelvic resections, are described. These patients were selected from a total group of 88 patients undergoing proximal femoral replacement, 75 of whom did not require capsular replacement (none of these 75 patients have experienced dislocation). In the group requiring capsular reconstruction, 1 of 4 patients with bipolar hemiarthroplasty and 4 of 9 patients with total hip replacements experienced dislocation after operation. Of the dislocated total hip replacements, 1 remains chronically dislocated, and 3 were successfully stabilized by open reduction with further capsular augmentation. Given that the resections involved removal of most of the soft tissues stabilizing the hip joint, we believe that the technique of capsular reconstruction is useful in this difficult group of patients.

Adult↗
PubMed1998

Hindquarter amputation for pelvic tumors. The importance of patient selection.

Twenty-two patients underwent hindquarter amputation with curative intent for malignant or locally aggressive tumors of the pelvis (21 cases) or proximal thigh (one case). In all cases, the ilium was resected, and in seven cases an osteotomy of the sacrum was done to achieve negative surgical margins. Only six wounds healed without complications. The worst wound problems occurred in patients requiring ligation of the common iliac vessels and in those requiring a sacral osteotomy. Twelve patients have died of disease, two are alive with extensive pulmonary metastases, and one remains well after excision of a local tumor recurrence. Thirteen of 14 patients with high grade sarcoma had metastases develop, compared with only one of eight patients with low grade sarcoma. Eight patients (all with high grade sarcoma) died within 1 year of surgery. Seven patients have remained disease free at a mean of 39 months after surgery. Given the poor prognosis and high morbidity after amputation in high grade sarcoma, the authors think that consideration should be given to pursuing nonoperative management in patients with large, high grade sarcomas and significant medical extension to the sacroiliac joint or sacrum.

Adolescent↗
PubMed1997

The cement mantle in the Exeter impaction allografting technique. A cause for concern.

The postoperative radiographs of 35 patients who underwent impaction allografting of the proximal femur were reviewed. Of Gruen zones that could be clearly visualized, 39.9% contained areas where cement was absent. Even when an adequate mantle was present, cement voids were commonly seen. These cement mantle deficiencies were confirmed in a series of cadaveric impaction allografting procedures. They appear to be a consequence, at least in part, of an inadequate differential between trial and actual component sizes. Additionally, 4 patients were identified with significant component migration secondary to radiographically visible cement mantle fractures within the first 6 months of surgery. It is concluded that the surgical technique requires modification to ensure a more consistent cement mantle and clinical result.

Adult↗
PubMed1997

The cement mantle in femoral impaction allografting. A comparison of three systems from four centres.

An analysis of the cement mantle obtained with the Exeter impaction allografting system at one centre showed that it was either deficient or absent in almost 47% of Gruen zones. We therefore examined the mantle obtained using this system at another hospital and compared the results with those from the CPT and Harris Precoat Systems at other centres. The surgical indications for the procedure and the patient details were broadly similar in all four hospitals. There was some variation in the frequency of use of cortical strut allografts, cerclage wires and wire mesh to supplement the impaction allograft. Analysis of the cement mantles showed that when uncertain Gruen zones were excluded, the incidence of zones with areas of absence or deficiency of the cement was 47% and 50%, respectively, for the two centres using the Exeter system, 21% for the CPT system and 18% for the Harris Precoat system. We measured the difference in size between the proximal allograft impactors and the definitive prosthesis for each system. The Exeter system impactors are shorter than the definitive prosthesis and taper sharply so that the cavity created is inadequate, especially distally. The CPT proximal impactors are considerably longer than the definitive prosthesis and are designed to give a mantle of approximately 2 mm medially and laterally and 1.5 mm anteriorly and posteriorly. The Harris Precoat proximal impactors allow for a mantle with a circumference of 0.75 mm in the smaller sizes and 1 mm in the larger. Many reports link the longevity of a cemented implant to the adequacy of the cement mantle. For this reason, femoral impaction systems require careful design to achieve a cement mantle which is uninterrupted in its length and adequate in its thickness. Our results suggest that some current systems require modification.

Acetabulum↗
PubMedDate not supplied

Hip dysplasia in Hurler's syndrome: orthopaedic management after bone marrow transplantation.

Hurler's syndrome is an autosomal recessive metabolic storage disease with distinct skeletal manifestations, which include progressive hip dislocation. Enzyme-replacement therapy by bone marrow transplantation improves life expectancy but does not prevent hip dislocation. We describe the features of hip dysplasia in a series of eight successfully engrafted patients with Hurler's syndrome. The primary pathologic condition appears to be a failure of ossification of the cartilaginous acetabulum. Five patients underwent bilateral hip-containment surgery, and all operated-on hips were reduced at a mean follow-up of 17 months. Innominate osteotomy would appear to be an essential part of the surgical procedure.

Arthrography↗
PubMedDate not supplied

Surgical approaches in revision hip replacement.

Revision hip arthroplasty will be performed with frequency in the future. A successful outcome depends on careful preoperative planning, and a key component of that plan is the surgical approach. The choice of the approach should be based on the indication for revision, the particular implant to be removed, the presence of acetabular or femoral bone loss, previous surgical approaches used, and the preferences and training of the surgeon. For simple revision procedures, one of the standard approaches used in primary hip arthroplasty may be adequate. More complex cases may necessitate an extended exposure or one of the techniques developed specifically for revision arthroplasty. No single approach is suitable for all revision procedures, and the surgeon must be familiar with a range of exposures if the clinical result is to be optimized.

Acetabulum↗
PubMedDate not supplied

Acetabular osteoblastoma: description of a case.

Osteoblastoma is a slow-progressing, benign bone tumor, that is not frequently observed in clinical orthopaedics (approximately 1% of all primary bone tumors). There is predilection for the vertebrae (posterior arch), the femur, the tibia, and the cranium; it affects young subjects (from 10 to 35 years), with predilection for males (males: females = 2:1). Symptoms are not very specific, characterized essentially by moderate, discontinuous pain, that is responsive to treatment by NSAIDS; it may, at times, be asymptomatic. On radiographic assessment it is viewed as a lytic area that is rounded, greater than 2 cm in size, with unclear margins, with or without peripheral bone reaction. It is not easy to diagnose osteoblastoma, particularly if it is localized in unusual sites, such as in the pelvis. The authors present a case of osteoblastoma of the acetabular bottom in a subject aged 22 years, that was not diagnosed unrecognized for about 2 years from the onset of symptoms.

Acetabulum↗