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Biomedical subjects

F E Stinchfield

Publications and source records attributed to F E Stinchfield.

14 recordsLinked to original sources
PubMed1989

The use of somatosensory evoked potential during revision or reoperation for total hip arthroplasty.

Somatosensory evoked potential (SSEP) was used to continuously monitor the sciatic nerve intraoperatively during revision or reoperation for total hip arthroplasty. Of 25 cases monitored, eight patients (32%) exhibited 12 instances of SSEP deterioration, indicating neurologic compromise. These neurologic problems were due to retraction in seven cases and limb positioning in five. No postoperative neurologic deficits were noted in this group. Two of 35 patients (5.7%) not monitored had postoperative neurologic deficits. SSEP monitoring is a useful method for minimizing the intraoperative risks of clinical neurologic deficits during revisions or difficult reoperations.

Adult↗
PubMed1979

Changes in metabolism and muscle composition associated with total hip replacement.

Metabolic changes in 10 patients undergoing total hip replacement were studied. Metabolic expenditure postoperatively remained within 5--10% of preoperative values. Net nitrogen loss for the postoperative period was less than 35 gm for the first 4 postoperative days, well below changes seen in major nonsurgical trauma. Fluid balance was positive in all patients for the first 4 postoperative days. Patients not in negative fluid balance by the fourth postoperative day should be closely monitored for complications. Recognition of delayed fluid excretion is essential in order to avoid the complications of further fluid loading in the postoperative period. Muscle composition reveals predictable changes in extracellular water, sodium, and chloride composition following surgery. Our data showed that metabolic changes following total hip replacement are in the order of major general surgical procedures and well below that observed with major trauma.

Adult↗
PubMed1979

The efficacy of low-dose heparin--warfarin anticoagulation prophylaxis after total hip replacement arthroplasty.

The prime therapeutic objective of prophylactic anticoagulation for patients undergoing total hip replacement is to reduce to a minimum fatalities from pulmonary embolism. Our low-dose heparin-warfarin prophylactic anticoagulation protocol affords significant protection in this regard (one fatal pulmonary embolism in 796 cases) without the use of venography or other objective tests to check for deep venous thrombosis and for all patients including those with venous disease or a history of prior thromboembolic disease. The 13.1% hematoma rate (5.0% late major) is a small, nonlethal, and acceptable price to pay for this protection.

Drug Therapy, Combination↗
PubMed1979

Sciatic paralysis. A complication of bleeding following hip surgery.

Of five patients in who sciatic paresis developed as the result of hemorrhage and hematoma following hip surgery, four were receiving prophylactic or therapeutic anticoagulants. The patient who was managed expectantly still had disabling motor and sensory deficity at follow-up. Three patients who had early operative decompression showed more complete return of nerve function. The fifth patient died three weeks after onset with the neuropathy still present. Severe low-back and buttock pain, ecchymosis over these regions, marked swelling in the thigh, sciatic-nerve tenderness, and a distal sciatic neural deficit in the ipsilateral lower limb of a patient who has had hip surgery are evidence of hemorrhage in the vicinity of the sciatic nerve. Early recognition and prompt surgical decompression can prevent irreversible nerve damage.

Adolescent↗
PubMed1978

Muscle and plasma amino acids after injury: the role of inactivity.

The amino acid pattern following total hip replacement is characterized by increases in muscle of the branched chain amino acids (leucine, isoleucine and valine), the aromatics (phenylalanine and tyrosine) as well as methionine. The nonessential amino acids in muscle tend to decline, glutamine having the most marked change. Plasma levels of the essential amino acids increase while the nonessentials tend to decrease. This pattern differs from that observed in other catabolic states (uremia, starvation, untreated diabetes) and is significantly different from the effects of inactivity and starvation combined. This suggests that injury can be characterized by a unique pattern of muscle and plasma amino acids.

Amino Acids↗
PubMed1977

The significance of intracapsular cultures in total hip operations.

In a consecutive retrospective study of 1,500 total hip replacements, analysis of cultures taken at the time of operation revealed that positive cultures obtained in primary arthroplasties are not significant. In our series, no statistical difference could be demonstrated between primary and revision arthroplasty cultures as related to joint infection, but on the basis of other clinical studies and the higher incidence of positive cultures in revision arthroplasty cultures as related to joint infection, but on the basis of other clinical studies and the higher incidence of positive cultures in revision arthroplasties, it is believed that these cultures should be treated vigorously. Further studies are being carried out to help clarify the role of prophylactic antibiotics in hip replacement operations in the prevention of postoperative hip joint infection. Antibiotic therapy for the treatment of potentially contaminated hips is also being reviewed. Such studies must be performed over a long term period.

Arthroplasty↗
PubMed1976

Systemic and local complications following low-friction arthroplasty of the hip joint. A study of 800 consecutive operations.

At the New York Orthopaedic Hospital, a study was made of postoperative complications in 800 consecutive total hip replacements of the Charnley low-friction arthroplasty type. Specially designed records made it possible to document and include all systemic and local complications of this procedure. While the rate of postoperative infection was low (less than 1%), thromboembolism and deep-vein thrombosis incidence was high despite the introduction of a prophylactic anticoagulation regimen. There were no deaths during or immediately after surgery, but six occurred within the first six weeks postoperatively. Two were due to a massive pulmonary embolus (proved at autopsy), two to myocardial infarction (clinical diagnosis), and one to a perforated cecum (proved at autopsy). The incidence of mechanical and technical failures in our series was relatively low and quite comparable with results reported by others.

Aged↗
PubMed1975

Complications of Austin Moore arthroplasty. Their incidence and relationship to potential predisposing factors.

In a retrospective computerized study of 451 Austin Moore arthroplasties (211 for acute hip fractures and 240 for hip reconstruction), the operative and general complications were correlated with the historical, preoperative, operative, and early and late postoperative factors usually thought to influence the results. Wound complications were significantly associated with diabetes and fracture, obesity and fracture, and procedures lasting two hours or more. General complications showing significant associations were: death or pneumonia with fractures, phlebitis with obesity, and myocardial infarction with fracture. Factors not significantly associated with complications included age, previous hip surgery, time of day of the operation, surgical approach, wound irrigation, use of drains, postoperative anticoagulation, and reaming of the acetabulum.

Acute Disease↗
PubMedDate not supplied

Adjuvant arterial embolization in the treatment of benign primary bone tumors in children.

This report presents an initial clinical experience with arterial embolization as adjuvent therapy in the surgical treatment of selected benign primary bone tumors in childhood. Embolization was dramatically effective in 4 children with spinal or pelvic vascular tumors. This technique facilitated local surgical resection and/or curettage. No child had evidence of local recurrence. Three of the 4 children had spinal cord or nerve root compression resulting in various degrees of paralysis prior to surgery. All treated patients had complete recovery from their paralysis. There were no complications of embolization or surgery. The treatment of benign primary bone tumors of the spine and pelvis is immeasurably improved by the adjuvant arterial embolization procedure. The immediate surgical treatment of these difficult tumors now becomes feasible with the greatly diminished blood flow resulting from embolization.

Adolescent↗