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Biomedical subjects

Henry D Clarke

Publications and source records attributed to Henry D Clarke.

7 recordsLinked to original sources
PubMed2003

The role of debridement: through small portals.

Arthroscopic debridement represents one option for treatment of the patient with degenerative arthritis of the knee. Numerous procedures, including joint lavage, removal of loose bodies, partial meniscectomy, and techniques to stimulate cartilage repair may be included under this topic. Understanding surgical indications and clinical results requires differentiation of these individual components where possible. Furthermore, it is important to note that degenerative changes present along a spectrum of involvement. However, despite patient heterogeneity, selective application of conservative debridement, partial meniscectomy and removal of mechanical irritants will result in improved midterm follow-up results in approximately two thirds of patients. Patient expectations are crucial, and the temporizing nature of the procedure must be understood.

Arthroscopy↗
PubMed2003

Routine patellar resurfacing: a viable option.

The literature on routine patellar resurfacing documents that the rate of anterior knee pain after TKA is the same whether the patella is resurfaced or unresurfaced. The complication rate is different in these groups. In patients in whom the native patella is left, the rate of reoperation is approximately 10%. However, when correct surgical technique is used, the rate of patellar complications after routine resurfacing is negligible. Although design modifications have helped reduce patellar complications, the surgeon is the most important variable. As long as good technique is used, routine patellar resurfacing has been proven to produce the best results in TKA.

Arthroplasty, Replacement, Knee↗
PubMed2003

Tibial tubercle osteotomy.

During primary and revision TKA, difficulties with exposure may be due to poor motion, obesity, and patellar baja. To gain accurate component positioning and avoid catastrophic complications with the extensor mechanism, a stepwise approach to optimizing the exposure should be used. In cases where the standard medial parapatellar arthrotomy is inadequate, a quadriceps snip is helpful. Occasionally, exposure will still be limited and in these cases, a tibial tubercle osteotomy can be used following the quadriceps snip. The tubercle osteotomy consistently heals postoperatively and results in less extensor lag than the V-Y quadricepsplasty. To minimize postoperative complications, strict attention to the operative technique should be maintained.

Algorithms↗
PubMed2003

Flexion instability in primary total knee replacement.

Although the results of TKR are highly successful at long-term follow-up, failures occur. One of the more frequent causes of failure is instability. In distinction to instability in the medial-lateral plane, AP instability in flexion has been poorly described until recently. Although acquired ligamentous incompetence can occur, particularly with cruciate retaining prostheses, many cases of flexion instability result from an intraoperative failure to create symmetric balanced flexion and extension spaces. In primary TKR, use of a well-designed posterior stabilized prosthesis and creation of symmetric balanced flexion and extension gaps should minimize the incidence of postoperative flexion instability. If flexion instability occurs, the role of nonoperative treatment is limited. In most cases, revision TKR using the same basic principles is required. When symmetric flexion and extension spaces cannot be produced intraoperatively in complex primary or revision surgery, use of a more constrained articulation, such as a constrained condylar prosthesis or hinged prosthesis, is required.

Arthroplasty, Replacement, Knee↗
PubMed2002

Long-term results of posterior cruciate-substituting total knee arthroplasty.

Posterior cruciate ligament-substituting total knee prostheses have been used extensively since the original posterior-stabilized condylar prosthesis was introduced more than 2 decades ago. The key design principle of this prosthesis was the incorporation of a cam and post mechanism on the femoral and tibial components. This mechanism was intended to function as a mechanical substitute for the posterior cruciate ligament, to optimize prosthesis roll back in flexion, and to avoid flexion instability by preventing posterior subluxation. Central to the use of these devices was the surgical technique, which required resection of both cruciate ligaments and creation of symmetric flexion and extension gaps with equal medial and lateral soft tissue tension. Modifications to the original design have been introduced gradually; these include changes to the patellofemoral geometry, and the addition of monoblock and modular metal-backed tibial components. Despite these changes, the key concepts of the prosthesis design and surgical technique have remained constant. The clinical results obtained with the use of these designs have been reported extensively. Long-term results at greater than 10 years continue to duplicate the outstanding early results with prosthesis survivorship exceeding 95% and high levels of patient function.

Arthroplasty, Replacement, Knee↗
PubMed2002

A fencepost solution.

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Arthroplasty, Replacement, Knee↗