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Biomedical subjects

H S Tullos

Publications and source records attributed to H S Tullos.

At least 55 records · Page 3Linked to original sources
PubMed1990

The effect of femoral component position on patellar tracking after total knee arthroplasty.

In a laboratory study, seven fresh anatomic knee specimens were evaluated to define the three-dimensional motions of the patella before and after total knee arthroplasty (TKA) with the AMK knee. The patella was displaced medially by an average of 4 mm and tilted medially by an average of 4 degrees after standard TKA. Medial translation or internal rotation of the femoral component further displaced and tilted the patella medially, but lateral translation or external rotation of the femoral component produced less predictable changes in patellar tracking. The patterns of patellar tracking after external rotation of the femoral component came closer to reproducing those of the intact knee than any other femoral component position. The high lateral ridge on the femoral component effectively prevents patellar dislocation but may produce abnormally high stresses on the patellar implant, especially if the implant is medially displaced or internally rotated. This could lead to accelerated wear or loosening of the patellar component.

Aged↗
PubMed1990

Intra-articular fibrous bands. Patellar complications after total knee replacement.

A syndrome of patellofemoral dysfunction, consisting of painful popping, catching, grinding, or jumping of the patellar component, can complicate total knee replacement. From October 1983 to March 1988, eleven of 635 total knee replacements had this syndrome. On arthroscopic evaluation, the dysfunction of the patellofemoral articulation was found to be secondary to intra-articular fibrous bands. In eight patients, a transverse fibrous band prevented the patella from seating well in the sulcus of the femoral component. In four patients, the fibrous band extended from the superolateral border of the patella to the infrapatellar fat pad, tethering the patella laterally. In one patient, the fibrous band extended from the distal pole of the patella to the intracondylar notch, tethering the patella inferiorly. In all patients, the symptoms resolved after arthroscopic removal of the fibrous bands.

Aged↗
PubMed1989

Alignment of total knee arthroplasty.

A series of 65 total knee arthroplasties performed by the senior author was evaluated to determine the effect of alignment on outcome. Radiographs and results of clinical examination were reviewed. Sixty-one of the 65 knees were in varus on the mechanical axis (ie, the weight-bearing line passed through the medial compartment). At an average follow-up period of 48 months, alignment was not found to affect incidence or progression of radiolucent lines, changes in tibial metaphyseal density, or clinical outcome (pain or range of motion). The authors were unable to confirm the historical belief that alignment is critical to the durability of cemented total knee arthroplasty, nor that the mechanical axis must pass through the center of the knee joint.

Adult↗
PubMed1989

The use of epidural morphine in patients undergoing total knee arthroplasty.

Sixty-six patients undergoing total knee arthroplasty were offered epidural morphine as a method of postoperative analgesia. Of the 66 patients, 50 completed the minimum protocol of 3 days in a special epidural monitoring unit and were thus available for study. In this study group, 86% stated that they obtained 75-100% relief of pain with each epidural injection. Greater than 90% of the patients rated the overall experience with epidural analgesia as excellent or good. Ninety percent stated that they would choose epidural morphine analgesia again if given the choice. Nausea and vomiting were the most common adverse effects, occurring in 34%. One patient experienced respiratory depression, which was reversed with Narcan. The most frequent complaint related to the procedure itself was the use of an apnea monitor; 18% of the patients considered this monitoring device intolerable. The progress of total knee arthroplasties in the epidural unit was monitored by range of motion achieved. At 72 hours the average motion was 10 degrees-87 degrees and at the end of the hospital stay was 6 degrees-98 degrees. The total hospital bill for epidural morphine analgesic patients was $469 more than for a conventional arthroplasty patient, though the mean duration of hospital stay was 1.7 days less for the epidural morphine patients. Epidural morphine provided excellent but inconsistent postoperative pain relief. When relief was present, aggressive in-house rehabilitation could be instituted, and a shorter overall hospital stay was achieved when compared with conventional analgesia. Nonetheless, the related adverse effects and inconsistent pain relief on many patients may preclude the use of epidural morphine as a single postoperative analgesic agent.

Adult↗
PubMed1989

Efficacy of antibiotics in low-velocity gunshot fractures.

We have investigated the efficacy of intravenous antibiotic therapy as a prophylactic measure to prevent infection following low-velocity gunshot fractures. Ninety-six consecutive patients were randomized prospectively to either an antibiotic group (Group I) or a nonantibiotic group (Group II) and were followed in a special gunshot wound clinic. Only patients with fractures that could be treated by closed techniques and did not require internal fixation were included. Sixty-seven patients (73 fractures) were followed radiographically. At follow-up, 36 fractures in Group 1 and 37 fractures in Group II comprised the study group. A total of two infections, one in each group, was documented. No significant infection prophylaxis was demonstrated by the use of intravenous antibiotics in these injuries.

Adolescent↗
PubMed1989

Metatarsal osteotomy for primary metatarsalgia: radiographic and pedobarographic study.

The effect of surgical procedures for primary metatarsalgia on the load distribution and bony architecture of the forefoot is poorly understood. A prospective study was performed on 45 feet with this diagnosis treated by dorsal wedge osteotomy and compared with 29 symptom-free contralateral feet. Each foot was evaluated preoperatively and postoperatively with quantitative radiographic analysis, a pedobarographic study, and by physical examination. Following osteotomy there was a 4.5-mm increase in average height from ground and a 7.0 psi decrease in pressure. The symptom-free control group demonstrated no statistically significant changes. Residual pain occurred with an average height increase of less than 3.5 mm and an average pressure decrease of less than 1.5 psi. Transfer lesions developed in three of four patients with a height increase of greater than 4.5 mm. The symptoms of metatarsalgia are altered by changes in height of the metatarsal or the pressure beneath it. It is not possible to predict the surgical elevation of the metatarsal head required to precisely decrease the pressure beneath the metatarsal head, thereby eliminating symptoms.

Adult↗
PubMed1989

Anterior discectomy, microscopic decompression, and fusion: a treatment for cervical spondylotic radiculopathy.

A consecutive series of 47 patients with cervical radiculopathy secondary to spondylosis were treated with complete discectomy, root decompression accomplished by microscopic foraminotomy on the affected side(s), and iliac graft fusion at the involved interspace(s). Forty of the 47 patients were contacted with an average follow-up of 15 months. Eighty-three percent of the patients were judged as having good results. Fusion of the involved interspace(s) occurred in 87% of cases, although this did not appear to correlate with the clinical results.

Adult↗
PubMed1988

Aspergillus discitis. Report of two cases and review of the literature.

Aspergillus discitis is a rare disease that usually occurs in immunocompromised hosts. In the one case reported in the orthopedic literature surgical debridement was required. Two additional cases, which occurred in intravenous drug abusers, are reported here. One case is unique in the orthopedic literature in that eradication of the disease occurred with chemotherapy alone.

Adult↗
PubMed1988

Simple dislocation of the elbow in the adult. Results after closed treatment.

The long-term results after treatment of simple dislocation of the elbow in fifty-two adults were evaluated with regard to limitation of motion, pain, instability, and residual neurovascular deficit. All patients were treated with traditional closed reduction, but the duration of immobilization before commencement of active motion varied. Goniometric, photographic, and radiographic data were compiled for these patients, who had an average follow-up of 34.4 months. Despite the generally favorable prognosis for this injury, 60 per cent of the patients reported some symptoms on follow-up. A flexion contracture of more than 30 degrees was documented in 15 per cent of the patients; residual pain, in 45 per cent; and pain on valgus stress, in 35 per cent. Prolonged immobilization after injury was strongly associated with an unsatisfactory result. The longer the immobilization had been, the larger the flexion contracture (p less than 0.001) and the more severe the symptoms of pain were. The results indicate that early active motion is the key factor in rehabilitation of the elbow after a dislocation.

Adolescent↗
PubMed1988

The anatomic basis of femoral component design.

The shape of the femoral canal is variable, much more variable, in fact, than most contemporary designs of femoral components would suggest or can accommodate. In the face of this variability, line-to-line or surface-to-surface contact is not expected between cementless implants and much of the endosteal surface. It also is apparent that changes in implant design are still needed if the normal biomechanics of the hip joint are to be restored in each patient and if component fixation is to be optimized. Most cementless components aim to achieve proximal load transfer to the femoral canal. However, increasing clinical evidence suggests that distal filling of the femur also is necessary to minimize the incidence of postoperative symptoms, particularly in revision procedures. If this is indeed the case, more accommodating designs of femoral components are needed that will enable proximal and distal fitting at the femoral canal so that stable fixation may be achieved regardless of variations in bone geometry.

Aging↗
PubMed1987

Contributory factors and etiology of sciatic nerve palsy in total hip arthroplasty.

Twenty-three peroneal and sciatic nerve palsies occurred in 21 patients following hip arthroplasty. Apparent risk factors included revision operations, being female, and significant lengthening of the extremity. The amount of lengthening was correlated with the development of either a peroneal palsy or sciatic nerve palsy. In cases of peroneal palsy the average lengthening was 2.7 cm (1.9 cm-3.7 cm) in comparison with 4.4 cm (4.0 cm-5.1 cm) for sciatic nerve palsies. Seven of these nerve palsies occurred among 614 consecutive patients treated at one institution during the period 1983-1985. This corresponded to an overall incidence of 1.1%. Electromyography demonstrated that peroneal stretch palsies originated primarily at the level of the neck of the fibula with some diffuse but lesser involvement along the proximal course of the peroneal division of the sciatic nerve.

Adult↗
PubMed1987

A new method for radiography of weight-bearing metatarsal heads.

A radiographic system has been developed that provides a standardized quantitative analysis of the forefoot. The patient stands fully weight-bearing on a horizontal plexiglass platform that is constructed to ensure reproducible placement between the cassette, patient, and beam. Measurements are made from the images of radiopaque rulers placed in line with the first metatarsophalangeal joint of each foot. The height of each metatarsal head can then be calculated based on measurements obtained on the radiograph. Graphs plotted from the data demonstrate the height of the metatarsal heads in a normal individual, changes in the height of the metatarsal heads with and without weight-bearing, before and after insole placement, and before and after metatarsal osteotomy. This information may be useful in obtaining a better understanding of abnormalities of the forefoot as related to bony anatomy and load distribution.

Forefoot, Human↗
PubMed1987

Intraarticular fractures of the distal humerus in the adult.

Intraarticular fractures of the distal humerus are notoriously difficult to treat. Three basic treatment methods are available: closed reduction, traction, and open treatment. In the past, functional results with all these methods generally have been poor because of disabling limitations of elbow motion. Thirteen adult patients were treated by open reduction and application of medial and lateral buttress plates providing rigid internal fixation and early motion. The patients were evaluated for range of motion, infection, nerve injury, avascular necrosis, myositis ossificans, varus/valgus deformity, pain, instability, weakness, and degenerative changes. Ten of the 13 patients were available for follow-up study for an average of two years. Nine of the ten achieved good or excellent results. Based on these observations, the treatment of choice is internal fixation with dual plates combined with early active postoperative motion.

Adolescent↗
PubMed1986

Adult elbow dislocations: mechanism of instability.

From these data it appears reasonable to advocate open repair of fracture dislocations of the elbow joint, particularly those associated with radial head fractures. In these instances improved functional results can be anticipated. In simple elbow dislocations in adults, it is possible that open repair of the medial collateral ligament will produce improved functional results. However, the data, although suggestive, are not conclusive at this time. It is our belief that the indications for surgery in elbow dislocations can be summarized as follows. Surgical intervention is indicated if spontaneous redislocation occurs, unless the arm is flexed above 90 degrees. Surgery is indicated if a spontaneous redislocation of the elbow dislocation occurs with the arm in plaster. Surgical repair of the medial collateral ligament is indicated in all instances of fracture dislocations of the elbow, particularly those associated with radial head fractures. In adult simple elbow dislocations surgical repair of the anterior oblique ligament certainly does not impair elbow function at follow-up and indeed may lead to better results.

Adult↗
PubMed1985

Lateral decompression for malunited os calcis fractures.

Nineteen heels in 19 patients underwent a lateral decompression for hindfoot pain secondary to a malunited os calcis fracture with subtalar intra-articular involvement. The operative procedure consisted of a lateral calcaneal bony prominence removal (ostectomy) and sural nerve release or transection. In addition, the peroneal tendons were released, relocated, and lengthened as necessary, with repair or reconstruction of their retinaculum. Eight patients (group I) had previously undergone a late subtalar fusion without relief of lateral symptoms. Eleven patients (group II) underwent a lateral decompression as an alternative to late subtalar fusion. In both groups combined, there were 14 males and 5 females with an average age of 40 years. The average follow-up was 28 months in group I and 17 months in group II. A satisfactory result was obtained in 75% (6 of 8) of the patients in group I and in 82% (9 of 11) of the patients in group II. This compares to a published success rate of approximately 50% in selected series in the literature and the authors' similar success rate of 46% for late subtalar fusion for the same pathology. The results suggest that the lateral decompression procedure offers a technically simpler yet effective alternative to late subtalar fusion for lateral pain following a malunited os calcis fracture with subtalar intra-articular involvement.

Adult↗