Biomedical subjects

G Jaroszynski

Publications and source records attributed to G Jaroszynski.

5 recordsLinked to original sources

PubMed2001

Development, test reliability and validation of a classification for revision hip arthroplasty.

The objective of the study was to develop a valid and reliable classification system for failed hip arthroplasties. The study uses research principals derived from multi-attribute utility theory and consensus group techniques. The development of the severity measure was done in two phases. Phase I of the study included: (a) questionnaire development, (b) submission of the questionnaire to the respondents, (c) data synthesis of the responses and item reduction, and (d) classification development and inter-observer reliability testing. Phase II included: (a) resubmission of the instrument to the respondents for suggestions/feedback, (b) instrument revision by the co-investigators based on the respondents' second feedback, and (c) inter-observer reliability testing and intraoperative validity testing of the instrument. The questionnaires sought to capture expert opinion as to what clinical determinants obtained preoperatively (during patient interview, physical exam and review of plain radiographs - AP pelvis and hip lateral) that would in their clinical experience reveal intraoperative severity. There was an 80% (16/20) response rate from the outside experts invited to participate in the study. Based on item reduction and test retest analysis, a five-grade radiographic classification for the acetabulum as well as the femur was developed. This system was then reviewed by 13 of the initial outside experts (16, 80%) who participated in the first round. Inter-rater reliability testing of the final format of the classification revealed a weighted kappa statistic value of 0.88 between the two-blinded raters (inter-rater reliability) and 0.87 between the blinded raters and the reference standard (intraoperative validity). We conclude that the study developed a reliable and valid radiographic classification system for failed hip arthroplasty.

Arthroplasty, Replacement, Hip↗

PubMed2001

Total hip replacement for the dislocated hip.

Replacing the dislocated hip is technically more challenging than replacing the subluxated hip. Overall, clinical and radiographic results have not been as good for hips that are completely dislocated. The surgical approach must allow for identification of the false and true acetabula, identification of the sciatic nerve, and lengthening of the leg. In patients with a dislocated hip who are managed with total hip replacement, coverage of the cup can be achieved by medialization, creation of a high hip center, or use of a structural graft. Bone grafting allows the cup to be placed in an anatomic position, provides bone stock for additional surgery, and restores leg length. Our results and the results of other authors confirm that these grafts remain intact for at least 10 years and restore bone stock for additional surgery. This is particularly important in this relatively young population.

Acetabulum↗

PubMed2000

Revision total hip arthroplasty with the use of structural acetabular allograft and reconstruction ring: a case series with a 10-year average follow-up.

From 1980 through 1993, 20 consecutive massive structural acetabular allografts and reconstruction rings were performed in 19 patients. In all cases, the magnitude of the acetabular bone deficiency was such that the allograft supported >50% of the cup. The allograft was necessary to restore normal anatomy, bone stock, and leg length. Of the 19 patients who met the inclusion criteria, 7 subjects died of unrelated causes, and 3 subjects failed and underwent resection arthroplasty, 1 (8%) for graft resorption and 2 (15%) for recurrent dislocation. The remaining 9 patients (10 allografts) had a minimum follow-up of 5 years and average follow-up of 10.5 years. The cohort was analyzed using radiographic and outcome data collection questionnaires (AAOS/HKOD, WOMAC, SF-36). The study supports the use of massive structural allografts and reconstruction rings and achieves satisfactory results in 77% (10 of 13) of the patients. We believe these results reveal an impressive outcome for what used to be thought of as a salvage operation.

Acetabulum↗

PubMed2000

Minor column structural acetabular allografts in revision hip arthroplasty.

A minor column (shelf) allograft is used for uncontained defects that involve less than 50% of the acetabulum. The prospectively collected records and radiographs of 47 patients (51 hips) who had undergone minor column structural acetabular allograft reconstruction during revision hip arthroplasty were reviewed. The purpose was to identify the long-term results (minimum 5 years) and factors that may influence longevity of the allograft and predispose the patient to subsequent acetabular component failure. The mean duration of followup was 119 months (range, 68-195 months). There was one perioperative death and six patients were lost to followup. Eleven patients (22%) required additional surgery. Three acetabular cups could not be revised successfully, despite multiple attempts, and the patients were treated with Girdlestone excisions. Eight patients underwent successful revision surgery with only three requiring a repeat structural allograft. Survival time for the acetabular cup as determined by Kaplan-Meier analysis was 153 months (95% confidence interval; range, 136-169 months). Cup failure was associated with more operative procedures performed before revision surgery (mean, 3.2 procedures), and failure to restore the vertical center of hip rotation to within 12 to 14 mm of the predicted value. The acetabular abduction angle was not a predictor for failure. The current study shows that good results can be achieved with structural acetabular allograft reconstruction with mid-term to long-term implant survival (cup aseptic survival, 80.4% and allograft re-construction survival, 94.1%), especially if there is restoration of near normal hip biomechanics.

Acetabulum↗

PubMed1996

Harvesting of the sural nerve with a tendon stripper.

The nerve most commonly used for peripheral nerve reconstruction is the sural nerve. The nerve can be dissected free through one long calf incision, by utilizing multiple small incisions, or by using a tendon stripper. We studied 12 above-knee amputation specimens harvesting the nerve in the ways described. We found that the length of nerve harvested averaged 32, 36, and 25 cm for the open, limited open, and stripper techniques, respectively. Epineurial damage occurred with the stripper, but no perineurial damage was documented histologically. We concluded that the closed method (stripper) of harvesting sural nerve would provide quality graft material, but of unpredictable length. When reliably long segments of nerve are required, at least a limited open or an open approach for harvest is recommended.

Humans↗