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Biomedical subjects

F Montgomery

Publications and source records attributed to F Montgomery.

At least 19 recordsLinked to original sources
PubMed1998

Arthrodesis of the ankle secondary to replacement.

One hundred total ankle arthroplasties were performed in our department between 1974 and 1994, and of these, 21 have been reoperated on with arthrodesis due to septic or nonseptic failures after 6 months to 15 years (median 40 months). Immobilization using a Hoffman external fixator was the dominating method. The total ankles were of six different designs. Sixteen of the 21 patients suffered from rheumatoid arthritis. Four of the 21 ankles did not fuse whereas 17 did: 13 at the first attempt and 4 after repeat arthrodesis. At the time of the review, two patients had died. Of the remaining 15 patients whose ankles had fused, all but one were satisfied or somewhat satisfied with the result. Twelve of these 15 ankles rated excellent or good according to the Mazur and Kofoed scoring systems. We conclude that arthrodesis can be performed successfully after a failed ankle arthroplasty.

Adult↗
PubMed1997

The natural history of idiopathic scoliosis. Incidence of treatment in 15 cohorts of children born between 1963 and 1977.

STUDY DESIGN: This study analyzed the incidence of treatment of scoliosis using a cross-sectional and a longitudinal technique. OBJECTIVES: To follow the incidence of treated scoliosis in Malmö, Sweden, in children born between 1970 and 1977 and compare observations with those of a study from 1988, in which the incidence of this disorder was followed in children born between 1963 to 1969. SUMMARY OF BACKGROUND DATA: During the late 1970s and early 1980s, the incidence of treated scoliosis decreased yearly in Malmö. This trend was supported by other reports. However, introduction of worldwide screening for scoliosis was a confounding factor. When cohorts of children born between 1963 and 1969 were analyzed, no change was found. In a study in Malmö in 1988, this was shown to be an effect of using a longitudinal instead of a cross-sectional technique of analyzing the data. METHODS: In a cross-sectional study, the authors registered all new treatments for idiopathic scoliosis, brace treatments, or direct surgery, for each year between 1984 and 1993. In a longitudinal study, all new treatments in each cohort of children born between 1970 and 1977 were followed. The results were compared with figures from the 1988 study. RESULTS: After the introduction of school screening in 1976, a peak in the incidence of treated scoliosis was seen in 1977. After a continuous decrease in the incidence until 1983, a steady state developed. In cohorts born between 1963 and 1977, the incidence is neither increasing nor decreasing. CONCLUSIONS: In cohorts of children followed in a longitudinal study over a 15-year period (born between 1963 and 1977), there is no support for a change in the natural history of idiopathic scoliosis.

Child↗
PubMed1997

Risk analysis of occupational factors influencing the development of arthrosis of the knee.

The aim of this study was to identify occupational activities important for the development of arthrosis of the knee, taking into account the confounding factors that were suspected or could be recognized. In the archives of the Department of Diagnostic Radiology at the Malmö University Hospital all radiographs of weight-bearing knees of patients with painful knee joints from the period 1982-1986 were reassessed. We found 340 probands, i.e., subjects with arthrosis of the knee of at least grade 1 in the Ahlback classification. These probands and their age- and sex-matched controls (680) were analyzed by a validated questionnaire for details of activities at work inducing knee moment over three 15-year-periods as well as their history of knee injuries at work or in their leisure time. The questionnaire was answered by 266 (79%) arthrosis probands and 463 controls (70%). The results of the questionnaire answers and of the recorded history of knee injuries were statistically analyzed by logistic regression. The relative risk of knee arthrosis was slightly increased (RR: 1.9; CI: 1.4-2.7) in probands with weight-bearing knee bending, i.e., dynamic load of the knee joint when bending, whereas knee injuries (meniscectomies and haemarthrosis) were associated with a higher risk. Weight-bearing knee bending corrected for confounders was not a significant factor for knee arthrosis. Overweight was observed to increase the relative risk. A sedentary profession had, on the other hand, a low risk. The knee injuries (66) were, but for 9 probands, sustained in leisure activities, mainly soccer. We thus conclude that work which induces weight-bearing knee bending by itself does not significantly increase the risk of developing arthrosis of the knee - knee injuries and overweight are more important.

Aged↗
PubMed1996

Knee moment at work: validation of a questionnaire based on knee moment in working life.

Classifications of occupations, such as those of the International Labor Organization, have previously been constructed with respect to the physical strain and joint moment to be expected in conjunction in a profession. To detect which occupational activities specifically induce high knee moments, we designed a questionnaire to analyze walking, knee bending, climbing of stairs and ladders, and jumping during three consecutive 15-year exposure periods in the professional lives of 920 consecutive residents [329 men with a mean age of 72 (range 47-96) and 561 women with a mean age of 77 (range 47-96)] drawn from the population records of the City of Malmö. The answers, classified into three categories with respect to knee joint moment, were compared with a classification of the occupations of all probands according to the same principles by three independent specialists in industrial hygiene. The two classifications showed a high degree of agreement, with Cramer's V ranging from 0.49 to 0.6, suggesting a co-variance with a common variable, i.e. the true work-related knee moment.

Age Distribution↗
PubMed1996

Continuous passive motion compared to active physical therapy after knee arthroplasty: similar hospitalization times in a randomized study of 68 patients.

68 consecutive patients who had primary knee arthroplasties because of arthrosis were randomized to postoperative continuous passive motion (CPM) or active physical therapy (APT). Rehabilitation in both groups was initiated on the first postoperative day. The CPM group sustained less postoperative knee swelling with more rapid initial improvement in knee flexion than did the APT group, but there were no differences between the groups in knee flexion at discharge. Postoperative pain rating and hospitalization times were similar in the two groups.

Aged↗
PubMed1994

Anterior ankle impingement arthropathy. The role of anterolateral arthrotomy and arthroscopy.

The choice of anterior ankle arthroplasty conducted by anterolateral arthrotomy versus arthroscopic techniques depends on the severity of the osteophytosis and the dominance type. This can be determined in most cases by conventional radiology, contrast arthrography, or MRI. Diagnostic arthroscopy may be required when noninvasive means fail to provide the answer to anterior frontier joint pain. Thorough arthroplasty must be performed and the joint placed through its end range of motion to verify reduction of all impingements. Extensive bony impingements are most effectively treated by conventional anterolateral arthrotomy. This is particularly true in posttraumatic cases with considerable arthrofibrosis infiltrate. Lesser degrees of osteophytosis confined, in particular, to the leading tibial edge are effectively reduced by arthroscopic technique. Anterior ankle arthroplasty by either technique offers symptomatic relief of pain with minimal morbidity. It can serve as a definitive treatment protocol for many patients or simply represent a temporary step along the way to more aggressive salvage surgery such as arthrodesis.

Ankle Injuries↗
PubMed1993

Screening for idiopathic scoliosis. Comparison of 90 cases shows less surgery by early diagnosis.

We assessed the final outcome of curve progression in 90 consecutive school children with idiopathic scoliosis. 46 children treated 1971-76 were compared with 44 treated 1978-81, after the introduction of school screening in 1977. There was a decrease in demand for surgery from 45 percent before screening to 10 percent in the screening group. When differences in subsequent brace types were accounted for, the outcome remained better in cases detected during the screening period. The most probable explanation is the earlier onset of bracing in the screened group.

Age Factors↗
PubMed1991

Cost effectiveness of blood substitution in elective orthopedic operations.

Cost effectiveness was compared between substitution with autologous blood, implying no risk of transmission of diseases, and homologous blood, with a definite risk of transmission. Primary and revision hip arthroplasties were included in this study, as well as scoliosis operations. The risk of contracting chronic non-A, non-B hepatitis (NANBH) was included in the calculations of the long-term economic consequences of a transmittable disease. Our study showed that predonated blood alone, with a donation of up to four units, was the most suitable and cost-effective method for substitution of blood losses up to about 2.5-3 liters A combination of predonated blood and intraoperative autotransfusion was more suitable and less expensive for substituting blood losses of 2.5 liters or more. Homologous blood was the least cost-effective alternative considering the influence of non-A, non-B hepatitis.

Adult↗
PubMed1990

Screening for scoliosis. A cost-effectiveness analysis.

The cost-effectiveness of three different screening methods was studied: the no specific screening, the conventional clinical screening, and the combined clinical moiré screening alternative. A multistage model of the treatment process was developed. Data from retrospective studies in Malmo were used. The costs for health care and production loss were calculated and applied to the time profiles of the three screening alternatives. Health care costs as well as costs in loss of production increased with the introduction of the conventional clinical screening program. However, when the clinical screening was combined with the moiré technique, the costs were markedly reduced. Thus, the combined clinical moiré screening would be the cost-effective way of using resources to prevent scolioses from developing into a more severe deformity.

Cost-Benefit Analysis↗
PubMed1988

How far does prophylaxis against infection in total joint replacement offset its cost?

Selection of a cost effective method of prophylaxis against infection for patients undergoing total joint replacement was shown to depend on the number of arthroplasties performed each year at individual hospitals. When 100 arthroplasties were performed each year the prophylactic use of systemic antibiotics minimised the total costs of the department--that is, the combined costs of prophylaxis and reoperation for deep sepsis. Some departments also used local antibiotic prophylaxis in the form of polymethylmethacrylate cement impregnated with gentamicin or a combination of systemic and local prophylaxis at almost as low a total cost and with comparable effect. Selection of a method of prophylaxis should not be determined solely on the basis of reducing costs. When a value was assigned to the effects of loss of health an economic optimum was established that allowed selection of a more costly method of prophylaxis together with further reductions in the incidence of infection and the need for reoperation.

Anti-Bacterial Agents↗
PubMed1988

The natural history of idiopathic scoliosis. A study of the incidence of treatment.

The natural history of idiopathic scoliosis has been studied between 1969 and 1985 in a well-controlled population of school children, 66,200 cases, between 7 and 16 years of age. The incidence of scoliosis needing treatment (25 degrees or more in progress in growing children) was studied with a cross-sectional as well as a longitudinal survey. When using a cross-sectional technique, a decrease of cases being treated was seen after the introduction of a conventional screening program--thus indicating a change in the natural history of moderate scoliosis. This could, however, be explained by the consequence of an accumulation of treated cases, formerly diagnosed and treated later on, seen immediately after the introduction of screening. When the longitudinal method was used, this trend could not be observed. And finally, when taking changes of indication of treatment and of the population into consideration, no tendency at all toward a change in the natural history could be seen.

Adolescent↗
PubMed1987

Heavy labor and the occurrence of gonarthrosis.

The prevalence of primary gonarthrosis was investigated in 332 men, (average age, 66 years) who had been doing heavy work for more than 30 years. Only subjects who had had symptoms and clinical studies, including a knee roentgen examination, were considered. Using the criteria of Ahlbäck, the prevalence of primary gonarthrosis was 3.9% in the laborers. In the age-matched internal and external controls, the prevalence was 1.4% and 1.6%, respectively. Circumstantial evidence suggests an association between heavy work and the incidence of gonarthrosis.

Aged↗
PubMed1986

Diet and faecal flora in three dietary groups in rural northern Nigeria.

Quantitative bacterial counts, concentrations of bile acids and bacterial enzyme profiles were measured in faecal samples from three tribal groups with distinctive dietary patterns in a rural area of northern Nigeria. Samples were obtained from Maguzawa (with a predominantly cereal diet), Hausa (cereal with regular meat consumption) and Fulani (cereal with frequent consumption of cows' milk). Numbers of bacteroides, clostridia and concentrations of bile acids were lower in the Maguzawa than the other dietary groups but these differences were not statistically significant. Bacterial enzyme profiles in each group were similar. The results are discussed with respect to possible influences of diet on the human intestinal microflora.

Adult↗