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Biomedical subjects

Giles R Scuderi

Publications and source records attributed to Giles R Scuderi.

At least 19 recordsLinked to original sources
PubMed2006

The influence of femoral component design in the elimination of patellar clunk in posterior-stabilized total knee arthroplasty.

Patellar clunk occurs after posterior-stabilized total knee arthroplasty and is believed to be a design-related complication. This study was undertaken to define the incidence of patellar clunk with an optimized third-generation, posterior-stabilized prosthesis. One hundred ninety three patients with 238 knees were evaluated at a minimum of 2 years after primary total knee arthroplasty with a cemented, NexGen Legacy Posterior-Stabilized prosthesis (Zimmer, Warsaw, Ind). The mean follow-up was 48 months (range, 24-72 months). No patient manifested symptoms of patellar clunk or underwent surgery for any patello-femoral problem. These results support prior evidence that femoral component design is the primary cause of patellar clunk and that modifications incorporated into this third-generation, posterior-stabilized prosthesis has eliminated the problem.

Adult↗
PubMed2006

Component asymmetry in simultaneous bilateral total knee arthroplasty.

Component size asymmetry and knee scores were determined in a review of 253 patients undergoing simultaneous or same-day, bilateral total knee arthroplasty (TKA). Asymmetry in component sizes was found in 22 (8.7%) pairs of femoral components, 17 (6.7%) pairs of tibial components, and 13 (5.1%) pairs of patellar components. Asymmetric and symmetric total knee arthroplasties were seen equally in men and women, and there was no statistical difference in knee scores and range of motion between patients with symmetric or asymmetric arthroplasties. Asymmetry rates for anterior referenced femoral components were significantly higher than posterior referenced components, an unexpected finding of unknown significance. Awareness of the incidence of component asymmetry and the practice of independent sizing of each knee during bilateral TKA is important to continue the success of bilateral TKA in a growing patient population.

Adult↗
PubMed2006

A third-generation, posterior-stabilized knee prosthesis: early results after follow-up of 2 to 6 years.

Two hundred seventy-nine primary total knee arthroplasties were performed with a modular, cemented, third-generation, posterior-stabilized prosthesis. At mean follow-up of 48 months (range, 24-72 months), the outcomes of 238 knees (85%) were evaluated with the Knee Society's Knee and Functional Scoring Systems and Roentgenographic Scoring System. The mean preoperative Knee Society Knee Score was 48 points compared with 96 points at latest follow-up. There were no cases of patellar clunk, symptomatic patellar maltracking, or posterior dislocation. There was no radiographic evidence of loosening or osteolysis, and no revisions were performed or recommended for loosening, osteolysis, instability, or polyethylene wear. Three patients developed late infections. These early results support the ongoing use of this design; however, long-term studies will be required.

Adult↗
PubMed2006

Blood loss management in high-risk patients undergoing total knee arthroplasty: a comparison of two techniques.

Although it is well known that patients with preoperative hemoglobin levels <13.0 g/dL are at a higher risk for requiring postoperative transfusions, the ideal blood management strategy for this group of patients remains unclear. This study compared preoperative autologous donation with preoperative administration of epoetin alfa as a method to maximize perioperative hemoglobin levels and minimize blood transfusions in these high-risk patients undergoing total knee arthroplasty (TKA). Results show that both preoperative autologous donation and epoetin alfa were successful in decreasing the need for allogeneic blood transfusions following TKA in high-risk patients. Epoetin alfa was more effective in maximizing perioperative hemoglobin levels.

Adult↗
PubMed2006

Use of multi-detector computed tomography for the detection of periprosthetic osteolysis in total knee arthroplasty.

This study determined the accuracy of plain radiography in detecting osteolytic lesions around total knee prostheses compared to multi-detector computed tomography (CT). Thirty-one patients diagnosed with periprosthetic osteolysis by multi-detector CT after total knee arthroplasty (TKA) were studied. Computed tomography for each patient was retrospectively reviewed in a blinded fashion. The plain radiographs for each patient that had been obtained prior to CT were reviewed in the same manner. The results of the CT were compared with the results of the radiographs. The number, size, and location of the lesions were compared. The multi-detector CT detected 48 lesions in 31 knees: 40 tibial lesions, 4 femoral lesions, and 4 patellar lesions. Radiographic diagnosis was made in 6 of the 40 tibial lesions, 2 of the 4 femoral lesions, and 0 of the 4 patellar lesions. Plain radiographs are inadequate for evaluating periprosthetic osteolysis in TKA with only 8 (17%) of 48 lesions detected by multi-detector CT visible on the standard radiographs. Multi-detector CT provides the surgeon with a diagnostic and preoperative planning tool when osteolysis is suspected.

Aged↗
PubMed2006

Management of bone loss: augments, cones, offset stems.

UNLABELLED: Trabecular metal augmentation has added new treatment options for severe proximal tibial bone defects in revision knee arthroplasty. Porous tantalum tibial cones provide mechanical support for the tibial component and have the potential for long-term biologic fixation. These cones facilitate restoration of the proximal tibia metaphysis in Type 2 and 3 defects. Ten tantalum tibial cones were press-fit into the prepared cavitary defect of a series of revision knee arthroplasties. Voids between the cone and host bone were filled with morselized grafting material. The core tibial component was cemented into the implanted tibial cone; fixation was enhanced with stem extensions, which were press-fit in four knees and cemented in six knees. Extensions ranged from 75-200 mm with length dependent upon the residual bone quality. Offset stems were used in 3 tibias. At follow-up (average 10 months), radiographic evaluation revealed no evidence of loosening or change in position. Strength, range of motion, and stability were comparable to previously reported series of revision arthroplasties. Trabecular metal cones can help reconstruct large cavitary defects and, along with stem extensions and offset stems, may eliminate the need for extensive bone grafting or structural allograft in revision knee arthroplasty. LEVEL OF EVIDENCE: Therapeutic study, level V (expert opinion). See the Guidelines for Authors for a complete description of levels of evidence.

Arthroplasty, Replacement, Knee↗
PubMed2006

Incidence of lateral release in total knee arthroplasty in standard and mini-incision approaches.

Minimally invasive total knee arthroplasty is a relatively new technique. There are limited clinical data on outcomes in patients having this procedure. We report the incidence of lateral release of the patella during total knee arthroplasty performed by one surgeon in 106 consecutive knees. The rate of release is compared between knees that received a mini incision with a limited medial parapatellar arthrotomy and those that received a standard approach. Our data suggest there is no correlation between size of incision and incidence of lateral release of the patella.

Aged↗
PubMed2006

The painful total knee arthroplasty: diagnosis and management.

The results of TKA during the past two decades have been reliable and favorable. While success rates are high, some patients experience pain and impaired function. This clinical scenario can be frustrating to both the patient and the surgeon who is accustomed to good outcomes. A systematic evaluation of the patient and arthroplasty can lead to a definitive diagnosis of the cause of the patient's symptoms. Problems can be caused by a broad spectrum of possible etiologies. It is helpful to divide the differential diagnosis into two broad categories: extra-articular and intra-articular etiologies. When trying to establish the diagnosis, it is important to approach the task in a systematic fashion. Evaluation must begin with a thorough history and physical examination. Laboratory tests and imaging studies can provide additional evidence supporting a particular diagnosis. Once the etiology has been established, symptomatic relief may be achieved with appropriate treatment including revision TKA. However, revision TKA that is performed for unexplained pain is associated with a low probability of success.

Algorithms↗
PubMed2006

Preoperative planning and perioperative management for minimally invasive total knee arthroplasty.

The introduction of minimally invasive surgery (MIS) has led to new clinical pathways for total knee arthroplasty (TKA). MIS TKA outcomes are affected by multiple factors--the surgery itself; preoperative planning and medical management; preoperative patient education; preemptive perioperative and postoperative analgesia; mode of anesthesia; optimal rehabilitation; and enlightened home care and social services-and therefore an integrated team approach to patient and surgery is required.

Analgesia↗
PubMed2006

Minimally invasive total knee arthroplasty: surgical technique.

The surgical techniques associated with the variety of minimally invasive surgery (MIS) approaches for total knee arthroplasty (TKA), including the limited parapatellar, limited midvastus, limited subvastus, and quadriceps-sparing approaches, are reviewed. The patient selection criteria for mini-incision TKA are detailed. Although clinical experience with these approaches is limited, initial results seem promising and potentially adaptable to a majority of cases with modifications in either instruments or components customized for the procedure. MIS TKA represents a continuum in complexity, and surgeons should gain experience sequentially. The extensibility of these approaches allows surgeons to adapt and modify the procedure should intra-operative difficulties arise.

Arthroplasty, Replacement, Knee↗
PubMed2005

Evaluation of the anterior cruciate ligament integrity and degenerative arthritic patterns in patients undergoing total knee arthroplasty.

We prospectively reviewed 107 consecutive primary total knee arthroplasties performed over a 1-year period. Intraoperatively, the integrity of the anterior cruciate ligament (ACL), the characteristics of the intercondylar notch, and the patterns of cartilage wear were evaluated. The ACL was found to be deficient in 41 knees (39%) at the time of surgery. The ACL-deficient knee had significantly narrower intercondylar notch widths compared with knees with an intact ACL (average, 9.75 vs 16 mm, P < .01). Furthermore, patients with ACL deficiency were found to have a higher percentage of Outerbridge grade IV changes at the lateral femoral condyle, lateral tibial plateau, and patellar surfaces when compared to the ACL-intact group. An intact ACL appeared to be protective against severe patellar degeneration. In conclusion, intercondylar notch narrowing from the arthritic process can lead to attrition and rupture of the ACL. An ACL deficiency appears to be associated increased wear of the lateral femorotibial and patellofemoral joints.

Adult↗
PubMed2005

The stiff total knee arthroplasty: causality and solution.

A stiff total knee arthroplasty is a disabling condition, which can be caused by technical errors, patient factors, and postoperative complications. The results of treatment are dependent on the cause of stiffness. The best treatment is prevention by providing preoperative patient education, aggressive postoperative rehabilitation, and avoidance of technical errors. Early manipulation may improve motion with a well-aligned component. Open arthrolysis and revision arthroplasty are indicated for chronic stiffness with component malposition or failure, incorrect component sizing, joint line displacement, or inadequate bone resection. When performing a revision arthroplasty, it is important to know the reason for failure and loss of motion because failure to identify the cause of stiffness may result in recurrence of the problem.

Arthroplasty, Replacement, Knee↗
PubMed2005

What would you do? Case challenges in knee surgery.

These knee arthroplasty cases were presented to a panel of surgeon and they represent classic clinical problems: (1) indications for unicompartmental arthroplasty; (2) total knee arthroplasty after a high tibial osteotomy complicated by infection and extensor mechanism rupture; (3) neuropathic arthropathy; (4) posttraumatic osteoarthritis with extraarticular deformity; (5) degenerative arthritis in the young patient; (6) osteoarthritis with a valgus deformity, fixed flexion contracture, degenerative scoliosis, and leg length discrepancy.

Adult↗
PubMed2005

Clinical results in valgus total knee arthroplasty with the "pie crust" technique of lateral soft tissue releases.

Numerous methods for creating symmetric flexion and extension gaps during knee arthroplasty in valgus knees have been proposed, and no consensus exists about the optimal technique. The "pie crust" technique for lateral soft tissue releases has been used extensively, yet few clinical results have been published. In this study, the clinical outcomes of 24 consecutive knees in 24 patients in whom this method was used in conjunction with a cemented posterior-stabilized prosthesis were evaluated. At a mean of 54 months' (range 24-69 months) follow-up, the knees were performing well with a mean Knee Society score of 97 (range 87-100) and mean range of motion of 121 degrees (range 100 degrees -145 degrees). Importantly, there were no clinical failures or cases of postoperative instability and no cases of radiographic loosening or wear.

Adult↗
PubMed2005

In vivo kinematic evaluation and design considerations related to high flexion in total knee arthroplasty.

In designing a posterior-stabilized total knee arthroplasty (TKA) it is preferable that when the cam engages the tibial spine the contact point of the cam move down the tibial spine. This provides greater stability in flexion by creating a greater jump distance and reduces the stress on the tibial spine. In order to eliminate edge loading of the femoral component on the posterior tibial articular surface, the posterior femoral condyles need to be extended. This provides an ideal femoral contact with the tibial articular surface during high flexion angles. To reduce extensor mechanism impingement in deep flexion, the anterior margin of the tibial articular component should be recessed. This provides clearance for the patella and patella tendon. An in vivo kinematic analysis that determined three dimensional motions of the femorotibial joint was performed during a deep knee bend using fluoroscopy for 20 subjects having a TKA designed for deep flexion. The average weight-bearing range-of-motion was 125 degrees . On average, TKA subjects experienced 4.9 degrees of normal axial rotation and all subjects experienced at least -4.4 mm of posterior femoral rollback. It is assumed that femorotibial kinematics can play a major role in patellofemoral kinematics. In this study, subjects implanted with a high-flexion TKA design experienced kinematic patterns that were similar to the normal knee. It can be hypothesized that forces acting on the patella were not substantially increased for TKA subjects compared with the normal subjects.

Arthroplasty, Replacement, Knee↗
PubMed2005

Minimal-incision total knee arthroplasty: the early clinical experience.

UNLABELLED: Minimal-incision total knee arthroplasty can be considered part of the continuum from traditional extensile exposures to the quadriceps-sparing approach. We did this study to identify preoperative variables that predict which patients are amenable to a mini-incision and mini-arthrotomy technique, and to compare early outcomes in these patients versus patients in whom a standard approach was required. A consecutive series of 118 primary total knee arthroplasties were evaluated. In each case, the incision and arthrotomy were kept as small as possible, while still allowing proper implantation of the prosthesis. Group 1 consisted of 69 patients (58%) with skin incisions smaller than 14 cm and limited medial parapatellar arthrotomies. Group 2 consisted of 49 patients (42%) with incisions greater than or equal to 14 cm and standard medial parapatellar arthrotomies. Patients in Group 1 averaged one size smaller femoral and tibial components, had narrower femurs, required fewer transfusions and had better postoperative flexion. There were no differences between the groups in length of hospital stay, ambulatory ability, stair-climbing, tourniquet time, radiographic alignment, or complications. Based on these results, the ideal patient for a minimal incision total knee arthroplasty and limited arthrotomy seems to be a thin woman with a low body mass index, a narrow femur, and good preoperative range of motion. LEVEL OF EVIDENCE: Prognostic study, Level III-1 (retrospective cohort study). See the Guidelines for Authors for a complete description of levels of evidence.

Aged↗
PubMed2005

Orthopaedic-induced anemia: the fallacy of autologous donation programs.

Total knee arthroplasty is associated with significant blood loss. Despite the initiation of various blood conservation modalities, allogeneic transfusion has yet to be eliminated. One hundred forty-eight patients who had unilateral primary total knee arthroplasties during a 3-year period were evaluated retrospectively for blood loss and transfusion rates. The patients were prescribed one unit of preoperative autologous donation that was to be transfused automatically on postoperative Day 1. Allogeneic transfusion was based on symptoms, and no numerical transfusion triggers were used. The preoperative autologous donation program resulted in increased preoperative anemia. Whereas only 26.2% of patients were in the high transfusion-risk group (hemoglobin >10 g/dL and < or = 13 g/dL) before surgery, 55.7% of patients were in this high-risk category after preoperative autologous donation. The patients did not recover from the autologous donations that occurred 4 weeks before surgery. A mean hemoglobin level of 14.0 g/dL was seen before donation, whereas the mean preoperative hemoglobin level decreased to 12.6 g/dL. We think that a preoperative autologous donation program leads to an increased risk of anemia before surgery.

Aged↗