Biomedical subjects

George J Haidukewych

Publications and source records attributed to George J Haidukewych.

At least 19 recordsLinked to original sources

PubMed2007

Femoral neck fractures in pediatric patients: 30 years experience at a level 1 trauma center.

Femoral neck fractures in children are severe injuries associated with the potentially disastrous complication of femoral head osseous necrosis. Our primary goal was to identify what factors contribute to the occurrence of femoral head osteonecrosis in skeletally immature patients with femoral neck fractures. We evaluated a large consecutive series of pediatric patients with femoral neck fractures. Between 1970 and 2000, 20 patients with a mean age of 11 years (range, 4-15 years) with femoral neck fractures were identified. All traumatic epiphyseal, transcervical, and basicervical (Types I, II, and III) fractures were included. There were 14 male patients and six female patients. The mean followup was 7 years (range, 1-28 years). Timing of surgery, type of fixation, and quality of reduction were analyzed with respect to the primary outcome measure-radiographic evidence of femoral head osteonecrosis. Eighteen of 20 hip fractures healed without complication; all had good or excellent reductions. Two patients had osteonecrosis develop; both had fair or poor reductions. Five patients were treated more than 48 hours after injury, including the two patients who had osteonecrosis develop. The mean time to fixation for the remaining patients was 12 hours. There was no relationship between capsular decompression and osteonecrosis development. Quality of reduction and timing of reduction influenced the risk of osteonecrosis.

Adolescent↗

PubMed2006

Hospital cost of dislocation after primary total hip arthroplasty.

BACKGROUND: The treatment of dislocation following primary total hip arthroplasty usually requires the use of expensive hospital resources and sometimes requires revision surgery. The hospital costs associated with treating this complication have not been previously analyzed, to our knowledge. The purpose of this study was to assess the financial impact of treating dislocations at our institution. METHODS: Between 1997 and 2001, 3671 patients underwent a total of 4054 consecutive primary total hip arthroplasties at our institution. The patients were prospectively followed at regular intervals, and their follow-up data were recorded in an institutional total joint registry. Ninety-nine hips (2.4%) in ninety-nine patients dislocated. The costs to our institution to treat these dislocations were evaluated by determining the cost of each treatment episode required to reestablish hip stability and were expressed as the percent increase in cost compared with that of an uncomplicated primary total hip replacement. RESULTS: Of the ninety-nine hips that dislocated, sixty-two (63%) remained stable after one or more closed reductions and thirty-seven (37%) ultimately required revision surgery. The hospital cost of each closed reduction episode represented 19% of the hospital cost of an uncomplicated total hip replacement. When revision surgery was eventually needed, the average hospital costs of one or more closed reductions and the subsequent revisions represented 148% of the hospital cost of an uncomplicated primary total hip replacement. CONCLUSIONS: Dislocation after primary hip replacement continues to be a prevalent and costly complication that diminishes the cost-effectiveness of an otherwise very successful surgical procedure.

Adult↗

PubMed2006

Intraoperative fractures of the acetabulum during primary total hip arthroplasty.

BACKGROUND: The intraoperative occurrence of an acetabular fracture is a rare complication of primary total hip arthroplasty. Previous reports have lacked a sufficiently large number of subjects to allow for an analysis of the causes and appropriate treatment of this problem. METHODS: Between 1990 and 2000, 7121 primary total hip arthroplasties were performed at our institution. We retrospectively reviewed the records in our Total Joint Registry and found that twenty-one patients (twenty-one hips) had sustained an intraoperative acetabular fracture. Nineteen of these patients (nineteen hips) had been followed until revision or for a minimum of two years (mean duration of follow-up, forty-four months). We evaluated the anatomic location, cause, treatment, and outcome of the fractures. Acetabular component designs were categorized as modular, nonmodular (monoblock), true hemispherical, or elliptical, and then each design was analyzed for fracture risk. RESULTS: No fractures occurred in association with cemented acetabular components. The fracture rate associated with uncemented components was 0.4%. In seventeen hips, the acetabular component was judged to be stable despite the detection of a fracture and the cup was retained. In four hips, the original cup was not stable and therefore was replaced with a design that allowed for supplemental screw fixation. All fractures united, and all cups demonstrated osseous ingrowth at the time of the most recent follow-up. Elliptical monoblock cups were associated with a significantly higher fracture rate than were elliptical modular cups (p < 0.0001) and hemispherical modular cups (p < 0.0001). There was no significant difference between elliptical modular and hemispherical modular components with regard to the fracture rate. CONCLUSIONS: Acetabular fracture during primary total hip arthroplasty is a rare complication of acetabular fixation without cement. In the present series, retention of a stable cup was associated with uneventful osseous ingrowth and excellent early-term outcomes. We found a high rate of fracture in association with the use of monoblock elliptical components. LEVEL OF EVIDENCE: Therapeutic Level III.

Acetabulum↗

PubMed2005

Total knee arthroplasty for salvage of failed internal fixation or nonunion of the distal femur.

Seventeen patients with a mean age of 66 years had total knee arthroplasty (TKA) performed to salvage failed internal fixation or nonunion of the distal femur. Two patients died at less than 2 years, both of whom were unrevised. The remaining 15 were followed for a mean of 5 years. Three arthroplasties failed, 1 by infection and 2 by mechanical failure. The 5-year survivorship free of revision for aseptic failure was 91% (72%-100%). There were 5 intraoperative complications (29%) and 5 postoperative complications (29%). The mean Knee Society pain score improved from 2 (range, 0-10) to 89 (range, 63-97), and the mean functional score improved from 2 (range, 0-25) to 45 (range, 10-90). TKA provided reliable pain relief and functional improvement for the great majority of patients. Functional scores and prosthesis survivorship, however, were inferior to those reported for primary TKA. The surgeries were difficult, and intraoperative and postoperative complications were common.

Adult↗

PubMed2005

Functional results after revision of well-fixed components for stiffness after primary total knee arthroplasty.

Between 1990 and 2001, 16 well-fixed, aseptic, primary total knee arthroplasties were revised in 15 patients for a diagnosis of stiffness. Patients were followed for a mean of 42 months (range, 2-6 years). Of 15 patients, 10 (66%) were satisfied with the results of the procedure. The mean Knee Society pain score improved from 28 to 65 points, and the mean functional score improved from 45 to 58 points. The mean arc of motion improved from 40 degrees preoperatively to 73 degrees postoperatively. Recurrent stiffness required additional intervention in 4 knees (3 patients, 25%). The results of revision of a well-fixed, stiff, primary total knee arthroplasty were mixed in our hands and provided only modest improvements in pain, function, and arc of motion. Key words: knee, arthroplasty, stiffness, revision, arthrofibrosis.

Aged↗

PubMed2005

Flexion instability without dislocation after posterior stabilized total knees.

UNLABELLED: Flexion instability after cruciate-retaining total knee arthroplasty has been well documented. We identified an analogous patient group with symptomatic flexion instability without dislocation after primary posterior stabilized total knee arthroplasty. We sought to determine the typical symptoms and exam findings that lead to the diagnosis, to assess the reliability of revision total knee arthroplasty as a treatment, and to assess the technical difficulties encountered during revision total knee arthroplasty. Between 1995 and 2001, 10 patients had revision of a well-fixed posterior stabilized total knee arthroplasty for isolated symptomatic flexion instability. The typical constellation of symptoms and physical findings included a sense of instability without giving way, recurrent knee effusions, multiple areas of soft tissue tenderness about the knee, and substantial anterior tibial translation at 90 degrees of flexion. The revision operation focused on balancing the flexion and extension gaps while taking care to fill the enlarged flexion gap. Revision total knee arthroplasty was reliable in alleviating pain (mean Knee Society Pain scores improved from 68 points preoperatively to 89 points postoperatively), improving stability (nine of 10 patients had < 5 mm anterior tibial translation postoperatively) and improving patient satisfaction (nine of 10 patients were satisfied). We had no particular technical difficulties with the revision total knee arthroplasty procedures and had reliably achieved well-balanced flexion and extension gaps. LEVEL OF EVIDENCE: Therapeutic study, Level IV-1 (case series). See the Guidelines for Authors for a complete description of levels of evidence.

Aged↗

PubMed2005

Motor nerve palsy following primary total hip arthroplasty.

BACKGROUND: Nerve palsy is a potentially devastating complication following total hip arthroplasty. The purpose of this study was to retrospectively identify risk factors for, and the prognosis associated with, a motor nerve palsy following primary total hip arthroplasty. METHODS: Between 1970 and 2000, 27,004 primary total hip arthroplasties were performed at our institution. Forty-seven patients (0.17%) with postoperative motor nerve dysfunction were identified by a review of the complications log of a total joint database. The medical record of each patient provided the data for this study. The average age of the patients was fifty-seven years at the time of surgery. The patients had serial clinical examinations for a minimum of two years, or until neurologic recovery or death. The nerve palsies were classified as complete or incomplete, and only patients with objective motor weakness were included in the study. The limb lengths were measured on preoperative and postoperative radiographs, and those data were then compared with the limb lengths in a matched cohort of patients who had not sustained a nerve injury after a primary total hip arthroplasty. The extent of neurologic recovery, the need for braces or walking aids, and the use of medications for neurogenic pain were evaluated. RESULTS: There were twenty-nine complete motor nerve palsies (sixteen peroneal, eleven sciatic, and two femoral) and eighteen incomplete motor nerve palsies (fourteen peroneal, three sciatic, and one femoral). A preoperative diagnosis of developmental dysplasia of the hip (p = 0.0004) or posttraumatic arthritis (p = 0.01), the use of a posterior approach (p = 0.032), lengthening of the extremity (p < 0.01), and cementless femoral fixation (p = 0.03) were associated with a significantly increased odds ratio for the development of a postoperative motor nerve palsy. Of the twenty-eight patients with a complete palsy who were available for follow-up, only ten (36%) had complete recovery of motor strength, which took an average of 21.1 months. Seven of the eighteen patients with an incomplete palsy fully recovered their preoperative strength. Twenty-one patients required walking aids, and fifteen required permanent use of an ankle-foot orthosis. Five patients required daily medication for chronic neurogenic pain. CONCLUSIONS: Motor nerve palsy is uncommon following primary total hip arthroplasty. A preoperative diagnosis of developmental dysplasia of the hip or posttraumatic arthritis, the use of a posterior approach, lengthening of the extremity, and use of an uncemented femoral implant increased the odds ratio of sustaining a motor nerve palsy. The majority of the motor nerve deficits in our series, whether complete or incomplete, did not fully resolve.

Aged↗

PubMed2004

Nonunion of fractures of the subtrochanteric region of the femur.

There are no large clinical series to guide the clinician treating a subtrochanteric nonunion. Deformity, bone loss from previous hardware, and the high stresses in the subtrochanteric region all pose challenges to achieving successful bony union with reoperation. The purpose of this study was to retrospectively review a consecutive series of patients treated with reoperation using contemporary techniques for subtrochanteric nonunion. Between 1992 and 2002, 23 patients with a mean age of 55 years (range, 16-88 years) with 23 subtrochanteric nonunions were treated with additional attempts to achieve union. Two patients were lost to followup. The remaining 21 patients were followed up for a mean of 12 months (range, 6-39 months). Implants used for revision internal fixation were as follows: eight patients were treated with a cephalomedullary nail, seven patients were treated with a standard antegrade femoral nail, five patients were treated with a 95 degree angled blade plate, one patient was treated with a sliding hip screw, one patient was treated with a 95 degree dynamic condylar screw, and one patient was treated with dual large fragment plates. Eighteen of 23 patients had bone grafting: eight had autograft, six had allograft, and both were used in three patients. One patient had free vascularized fibular transfer. Twenty of 21 nonunions healed (95%). At last followup, all patients with healed fractures had no or minimal pain. All were ambulatory. There were no intraoperative complications. There was one postoperative complication (4%), an adynamic ileus that was treated medically. Revision internal fixation and selected bone grafting for subtrochanteric nonunion led to a high rate of fracture union and functional improvement. Intramedullary devices with fixation into the femoral head and neck and fixed angled devices were effective in achieving stable fixation of the proximal bony fragment.

Adolescent↗

PubMed2004

Management of pathologic fractures of the proximal femur: state of the art.

Metastases to bone are the most common cause of a destructive lesion of the skeleton in an adult. The proximal femur is the most commonly affected bone with metastatic disease in the appendicular skeleton. A systematic approach to patient management is critical, so as to avoid complications that will delay systemic therapy. The orthopedic traumatologist is often the first physician to see the patient with a pathologic fracture. As a result, the surgeon must be aware of the indications for resection versus internal fixation, as well as options for reconstruction. Polymethyl methacrylate and curettage can be useful in the appropriately selected patient. Postoperative external beam irradiation can significantly reduce disease progression and subsequent loss of fixation. A multidisciplinary approach to this patient group will help optimize prognosis as well as function. This article reviews the evaluation, management, and complications of treatment of pathologic fractures of the proximal femur, with an emphasis on metastatic disease and multiple myeloma.

Femoral Fractures↗

PubMed2004

Complications and results of arthroplasty for salvage of failed treatment of malignant pathologic fractures of the hip.

The purpose of this study was to evaluate the results and complications of hip arthroplasty done for salvage of failed treatment of pathologic proximal femoral fractures secondary to malignancy. Between 1980 and 2000, 42 patients with a mean age of 63 years were treated with hip arthroplasty to salvage failed treatment of a pathologic proximal femoral fracture. Total hip arthroplasty was done in 16 patients (3 uncemented, 2 hybrid, 11 cemented), and bipolar hemiarthroplasty in 26 (2 uncemented, 24 cemented). A modular, proximal femoral replacement construct was used in 15 patients. Patients were followed a mean of 5.8 years (range, 15 days-20 years). Four hips required reoperation, all for deep infection. Harris Hip score improved from an average of 42 points (range, 17-76 points) preoperatively to an average of 83 points (range, 52-100 points) postoperatively. Most recent radiographs showed femoral component loosening in only one patient. Implant survivorship free of revision for any reason at 5 years was 90% (range, 65-96%) and free of revision for aseptic failure or radiographic failure was 97% (range, 64-99%). Hip arthroplasty is an effective treatment for salvage of failed treatment of pathologic proximal femoral fractures. Modular proximal femoral replacements were often required. The most concerning complication was deep prosthetic infection, which occurred in nearly 10% of this patient population, and in 21% of patients with prior irradiation.

Adult↗

PubMed2004

Wound complications after open Achilles tendon repair: an analysis of risk factors.

Operative treatment of Achilles tendon ruptures has the risk of wound complications. The purpose of this study is to determine the risk ratio for specific risk factors associated with wound related complications in patients with operatively treated Achilles tendon ruptures. Between 1978 and 2001, 167 open Achilles tendon repairs were done at our institution. Clinical data were retrospectively reviewed. Tobacco use, diabetes, age, gender, timing of surgery, body mass index and steroid use were evaluated as potential risk factors for wound healing complications. One patient was lost to follow-up and two patients had nonsimultaneous ruptures and only the first repair was included; the remaining patients were followed up until complete wound healing. There were 17 wound complications in 164 patients (10.4%). Significant risk factors for development of wound complications included tobacco use (p < 0.0001), steroid use (p = 0.0005), and female sex (p = 0.0400). For those patients who had one or more of the following risk factors: diabetes, tobacco use, or steroid use; eight of 19 (42.1%) had a complication, compared with nine of 145 (6.2%) for those without risk factors present (p < 0.0001). Surgeons doing open Achilles tendon repairs should be cognizant of the specific risk factors identifled in this study, because they might impact decision making with regard to operative versus nonoperative treatment.

Achilles Tendon↗

PubMed2004

Systemic safety of high-dose antibiotic-loaded cement spacers after resection of an infected total knee arthroplasty.

The purpose of this study was to assess the systemic safety and potential adverse effects of using a high-dose antibiotic-impregnated cement spacer after resection arthroplasty of an infected total knee replacement. Between October 2000 and December 2002, 36 knees (34 patients) had a resection arthroplasty of an infected total knee prosthesis with placement of a high-dose antibiotic impregnated cement spacer. There were 24 men and 10 women with a mean age of 66.5 years (range, 48-84 years). All spacers placed contained an average of 3.4 batches of cement with an average total dose of 10.5 g of vancomycin (range, 3-16 g) and 12.5 g of gentamicin (range, 3.6-19.2 g). All patients were followed up post-operatively until reimplantation for evidence of renal failure. The preoperative creatinine ranged from 0.7 to 1.8 mg/dL. All patients were concomitantly treated with 6 weeks of intravenous organism-specific antibiotics. One patient with normal preoperative renal function (Cr 0.7 mg/dL) had a perioperative 1-day transient rise in serum creatinine (1.7 mg/dL) postoperatively that subsequently normalized. No patients showed any clinical evidence of acute renal insufficiency, failure, or other systemic side effects of the antibiotics. Treatment of patients with an infected total knee arthroplasty with high-dose vancomycin and gentamicin antibiotic spacers seems to be clinically safe.

Aged↗

PubMed2004

Operative treatment of femoral neck fractures in patients between the ages of fifteen and fifty years.

BACKGROUND: There is a paucity of data on the treatment of femoral neck fractures in young patients. The purpose of the present study was to review the results and complications associated with the treatment of femoral neck fractures with internal fixation in a large consecutive series of young patients. METHODS: Between 1975 and 2000, eighty-three femoral neck fractures in eighty-two consecutive patients who were between fifteen and fifty years old were treated with internal fixation at our institution. Two patients died, and eight were lost to follow-up. Seventy-three fractures were followed until union, until conversion to hip arthroplasty, or for a minimum of two years; the mean duration of follow-up was 6.6 years. Fifty-one of the seventy-three fractures were displaced, and twenty-two were nondisplaced. The results and complications of treatment were retrospectively reviewed, and the effects of fracture displacement, reduction quality, and capsular decompression on outcome were evaluated. Function was assessed by evaluating pain, walking capacity, and the need for gait aids. The mean duration of follow-up for the fifty-seven patients (fifty-eight fractures) who had not undergone early conversion to arthroplasty was 8.1 years. RESULTS: Fifty-three (73%) of the seventy-three fractures healed after one operation and were associated with no evidence of osteonecrosis of the femoral head. Osteonecrosis developed in association with seventeen fractures (23%), and a nonunion developed in association with six (8%). Four of the six nonunions later healed after a secondary procedure. At the time of the final follow-up, thirteen patients had had a conversion to a total hip arthroplasty because of osteonecrosis (eleven), nonunion (one), or both (one). Five (9.8%) of the fifty-one displaced fractures were associated with the development of nonunion, and fourteen (27%) were associated with the development of osteonecrosis. Three (14%) of the twenty-two nondisplaced fractures were associated with the development of osteonecrosis, and one (4.5%) was associated with the development of nonunion. Eleven (24%) of the forty-six displaced fractures with a good to excellent reduction were associated with the development of osteonecrosis, and two (4%) were associated with the development of nonunion. Four of the five displaced fractures with a fair or poor reduction were associated with the development of osteonecrosis, nonunion, or both. CONCLUSIONS: The ten-year survival rate of the native femoral head free of conversion to total hip arthroplasty was 85%. Osteonecrosis was the main reason for conversion to total hip arthroplasty, but not all patients with osteonecrosis required further surgery. The results of treatment were influenced by fracture displacement and the quality of reduction.

Adolescent↗

PubMed2004

Long-term results of total hip arthroplasty for femoral neck fracture nonunion.

BACKGROUND: Hip arthroplasty for the treatment of nonunion at the site of a femoral neck fracture has provided good short-term results. The purpose of the present study was to evaluate the long-term results and complications of total hip arthroplasty for the treatment of femoral neck nonunion. METHODS: The records of ninety-nine patients who had been managed with total hip arthroplasty with use of a cemented Charnley acetabular component and a cemented Charnley monoblock femoral component for the treatment of a femoral neck nonunion were retrospectively reviewed. The average age at the time of the arthroplasty was sixty-eight years. Eighty-four patients (85%) were followed until death, revision, or component removal or for at least two years (mean, 12.2 years) postoperatively. RESULTS: Twelve patients were treated with revision (eleven) or resection arthroplasty (one), eleven were lost to follow-up, and four died less than two years postoperatively. Of the remaining seventy-two unrevised hips that were followed for at least two years, sixty-nine (96%) had no or mild hip pain at the time of the last follow-up. The rate of component survival free of revision or removal for any reason was 93% at ten years and 76% at twenty years. The risk factors that were significantly associated with revision for aseptic loosening included an age of less than sixty-five years at the time of the arthroplasty (p = 0.045), a body-mass index of >/=30 (p < 0.01), and male gender (p = 0.02). The second most common complication after loosening was dislocation, which occurred in nine patients (9%). CONCLUSIONS: Total hip arthroplasty is an effective method for the treatment of nonunion of the femoral neck and provides satisfactory long-term results. However, the rate of implant survival is poorer than that reported in most other studies of Charnley total hip arthroplasty in the general population.

Adult↗

PubMed2003

Acute compartment syndrome of the leg following diagnostic electromyography.

Acute compartment syndrome of the lower extremity is typically associated with some form of trauma, either fracture or blunt injury. Accurate diagnosis and urgent treatment of this condition is required for preservation of the viability of the limb. We report the case of a 73-year-old man who developed an acute compartment syndrome of the leg after diagnostic electromyography. Potential causes and treatment are discussed.

Acute Disease↗

PubMed2003

A technique for treating periprosthetic fractures of the femur associated with deep prosthetic infection.

In this report a case of periprosthetic fracture of the femur associated with deep prosthetic infection after a total hip arthroplasty is treated in a novel way that allows for stabilization of the fracture and the delivery of local antibiotics. The technique allows the surgeon to stabilize the fracture and deliver antibiotics locally with a cement-coated Enders nail. This technique is useful in this combination of difficult problems as it facilitates the goals of eradicating infection, alleviating pain and improving function.

Aged↗

PubMed2003

Placement of half-pins for supra-acetabular external fixation: an anatomic study.

An alternative location for placement of half-pins during pelvic external fixation is the dense supra-acetabular bone in the region of the anterior-inferior iliac spine. Although these fixators have gained popularity, to the authors' knowledge there are no studies evaluating the potential anatomic risks of placement of half-pins in this area; no safe corridors have been defined. Additionally, pins are placed near the hip capsule and no studies exist defining the superior extent of the hip capsule which potentially may be violated by placing half-pins in this location. The purposes of the current study were to evaluate the neurovascular risks and accuracy of fluoroscopically guided percutaneous placement of supra-acetabular half-pins, and to evaluate the anatomic superior extent of the hip capsule. Ten fresh frozen cadaveric pelves were used. A 5-mm half-pin was placed in the supra-acetabular bone under fluoroscopic guidance. Iliofemoral dissection was done and the proximity of the half-pin to local neurovascular risks was measured with a caliper. The hip capsule was exposed and the superior extent of the hip capsule was measured. Intraosseous pin placement was evaluated by direct observation. Nine pins were completely in bone, one had partially exited posteriorly and laterally. The lateral femoral cutaneous nerve was at risk with a mean distance of 10 mm (range, 2-25 mm) from the half-pins. The femoral nerve and femoral artery were not at risk. The average superior extent of the hip capsule was 16 mm above the joint (range, 11-20 mm). Half-pins can be placed accurately and safely in the supra-acetabular region using percutaneous techniques, appropriate soft tissue sleeves, and fluoroscopic guidance. Insertion of pins at least 2 cm above the hip is recommended to avoid potential hip capsule penetration.

Bone Nails↗

PubMed2003

Salvage of failed internal fixation of intertrochanteric hip fractures.

Most intertrochanteric hip fractures treated with internal fixation heal. If nonunion or early loss of fracture fixation occurs, treatment options include prosthetic replacement and revision internal fixation. The purpose of the current study was to evaluate the results of revision internal fixation and bone grafting for salvage of failed internal fixation of intertrochanteric hip fractures. Between 1981 and 2000, 20 patients with 20 intertrochanteric fractures who had initial internal fixation that failed were treated with revision open reduction and internal fixation and bone grafting. The mean age of the patients was 58 years (range, 21-86 years). The mean clinical followup was 27 months (range, 3-120 months), and mean radiographic followup was 22 months (range, 3-120 months). Eleven patients were treated with an angled blade plate (seven, 95 degrees; two, 90 degrees; one, 110 degrees; and one, Harris blade plate), five with a dynamic hip screw, three with a dynamic condylar screw, and one with a Zickel nail. Autograft bone was used in 17 patients and allograft bone was used in three patients. Nineteen of 20 nonunions healed (95%). Sixteen of the 19 patients who achieved healing reported no pain and three had mild pain (related to retained hardware); all were ambulatory. Two patients had perioperative complications (10%): one wound dehiscence, and one severe hyponatremia. In properly selected patients, revision internal fixation with bone grafting for failed open reduction and internal fixation of intertrochanteric hip fractures can provide a high rate of union and good clinical results with a low rate of complications.

Adult↗