PubMed Health⌕ Search

Biomedical subjects

I Stockley

Publications and source records attributed to I Stockley.

At least 37 records · Page 2Linked to original sources
PubMed1997

Histologic evidence of cortical allograft bone incorporation in revision hip surgery.

There is no published evidence concerning the histology of cortical allograft bone implanted during revision arthroplasty surgery. Five cases are reported in which cortical allograft bone had been used where biopsies were available between 2 and 27 months after implantation. All cases showed favorable histologic features, with soft tissue attachment by fibrous adhesion, union of graft to host, and osseous remodeling.

Adult↗
PubMed1997

Reconstruction of massive bone defects with allograft in revision total knee arthroplasty.

Allograft bone was used to reconstruct a defect in the proximal aspect of the tibia or the distal aspect of the femur, or both, in thirty knees of twenty-eight patients who had a revision total knee arthroplasty. The average age of the patients at the time of the index procedure was 65.8 years (range, twenty-four to eighty-nine years). At an average of fifty months (range, twenty-four to 132 months; median, thirty-six months) postoperatively, the score for twenty-three knees (twenty-one patients) had increased by at least 20 points, and these knees did not need additional operative treatment. Thus, the rate of success was 77 per cent. The procedure was considered a failure for the remaining seven knees because of infection (three), loosening of the tibial component (two), fracture of the graft (one), and non-union at the allograft-host junction (one). Properly applied allograft can be used to reconstruct massive bone defects, provide stability and support for implants, and restore bone stock in the event that additional operative treatment is necessary.

Adult↗
PubMed1996

Total hip replacement in dysplastic hips using femoral head shelf autografts.

A consecutive series of 30 dysplastic hips were treated with total hip arthroplasty using femoral head autograft shelf reconstruction and were reviewed. Cemented cups were used in 13 hips and uncemented cups were used in 17 hips. The average followup was 8.1 years (range, 5.2-13.3 years). In the cemented group, the average preoperative Harris Hip Score was 44.8 points (range, 22-82 points), and in the uncemented group, it was 45 points (range, 23-61 points). At the final review, the average clinical score was 71.5 points (range, 46-98 points) in the cemented group, and in the uncemented group it was 87.5 points (range, 63-100 points). Of the 30 cases, only 3 had unsuccessful results, giving a success rate of 90%. In terms of the autograft, all united to host bone. Resorption, when seen in either cemented or uncemented cups, was minor and restricted to the lateral nonweightbearing part of the graft. The present study supports using shelf autografts to reconstruct dysplastic hips at the time of total hip arthroplasty. In this series, cemented and uncemented cups performed equally well.

Adult↗
PubMed1996

Biochemical properties of cortical allograft bone using a new method of bone strength measurement. A comparison of fresh, fresh-frozen and irradiated bone.

There have been conflicting reports on the effects of gamma irradiation on the material properties of cortical allograft bone. To investigate changes which result from the method of preparation, test samples must be produced with similar mechanical properties to minimise variations other than those resulting from treatment. We describe a new method for the comparative measurement of bone strength using standard bone samples. We used 233 samples from six cadavers to study the effects of irradiation at a standard dose (28 kGy) alone and combined with deep freezing. We also investigated the effects of varying the dose from 6.8 to 60 kGy (n = 132). None of the treatments had any effect on the elastic behaviour of the samples, but there was a reduction in strength to 64% of control values (p < 0.01) after irradiation with 28 kGy. There was also a dose-dependent reduction in strength and in the ability of the samples to absorb work before failure. We suggest that irradiation may cause an alteration in the bone matrix of allograft bone, but provided it is used in situations in which loading is within its elastic region, then failure should not occur.

Adolescent↗
PubMed1993

A prospective study of diagnostic epidural blockade in the assessment of chronic back and leg pain.

A consecutive series of 100 patients with back and leg pain were evaluated prospectively. All had a detailed clinical assessment together with radiculography and computed tomography (CT) of the lumbosacral spine. In addition, each patient underwent diagnostic epidural blockade that identified three kinds of response. Injection of local anaesthetic into the epidural space relieved the symptomatic pain--the positive result (51 patients). Local anaesthetic injection had no effect on the symptomatic pain--the negative result (30 patients). In 19 patients, saline injection into the epidural space relieved the symptomatic pain--the placebo result. The results of this investigation were assessed in the light of the number of inappropriate physical signs found on clinical examination, together with the result of the radiculogram and CT scan. No statistical correlation was found with any of these parameters.

Adult↗
PubMed1993

Exchange arthroplasty for infected knee replacements. A new two-stage method.

We report a series of 17 exchange arthroplasties for infected knee prostheses, ten one-stage and seven two-stage procedures. The method proved successful in controlling infection and restoring function. In two-stage exchanges the interval between the stages was managed by using a prosthesis as a spacer, and acrylic cement beads containing the appropriate antibiotic to provide high local concentrations. Three one-stage procedures had recurrence of infection, but were successfully treated by further exchange operations. All patients had satisfactory function and there have been no serious complications. We recommend this modified two-stage technique for the management of infected knee arthroplasties.

Administration, Topical↗
PubMed1993

Bone grafts in hip replacement surgery. The pelvic side.

Replacement arthroplasty of the hip may require restoration of bone stock to provide support for the acetabular implant and to restore anatomy and leg lengths. This article discusses the indications, surgical technique, results, and controversies of using bulk autograft bone to provide cup support for primary hip replacement in hip dysplasia. In addition, the use of allograft bone to restore bone stock in the revision situation is covered. The indications, surgical technique, and results of the use of both morsellized and bulk allograft bone are presented.

Acetabulum↗
PubMed1992

Clinical and radiographic results of the Muller straight stem used as a press-fit.

Prior to the introduction of porous coating, 21 patients had 24 ME Muller straight-stem femoral prostheses inserted as a press fit for the treatment of osteoarthrosis. Five hips have been revised for aseptic loosening; the remaining 19 prostheses are still in situ after a mean of 7.3 years (range, 6.2-8.3 years). A prospective clinical assessment has been undertaken using a modified Harris hip score, with scores increasing on average from a preoperative 43 to a postoperative 79. Eighteen of the 19 remaining hips are functioning well. Variable distances of subsidence are evident in 10 hips. Despite the use of a prosthesis that was not designed for cementless proximal wedge fitting, the results indicate an exceptionally low incidence of bone resorption and lysis. Unlike cemented and some porous-coated prostheses, stress shielding and osteopenia were not a feature in this series.

Aged↗
PubMed1992

Allograft reconstruction in total knee arthroplasty.

We reviewed 32 deep-frozen irradiated allografts used for the reconstruction of bone defects in 20 knees. They were subdivided into bulk grafts, cortical strut grafts, and morsellised bone. The average follow-up was 4.2 years (2 to 7.2). Radiographs showed union of the allograft to the host in all cases. Two allografts later fractured and three knees required further surgery because of infection. The allografts effectively filled large bone defects around the knee, lessening the need for custom-made and constrained prostheses.

Adult↗
PubMed1991

Flexible intramedullary pins in the treatment of unstable proximal humeral fractures.

A series of 35 proximal humeral fractures treated with flexible intramedullary pins between 1986 and 1988 are presented. Special design features of the pins include a proximal 15 degrees angulated 20 mm tip and a 20 mm curve distally. The method is suitable for fractures in the surgical neck with displacement of bone width (AO-type A2/2). In cases of fracture-dislocation or three- or four-part fractures it is only suitable when the fragments can be reduced satisfactorily. Complications are minimal with 95 per cent bone union.

Bone Nails↗
PubMed1990

The importance of the valgus hindfoot in forefoot surgery in rheumatoid arthritis.

The relationship between hindfoot deformity and forefoot pressure was assessed in 28 rheumatoid patients who had undergone forefoot reconstruction four years previously. Patients with valgus hindfoot deformities tended to have high forefoot pressures whereas those with a normal hindfoot recorded normal pressures on the dynamic pedobarograph. All patients with residual forefoot pain recorded abnormal forefoot pressures. We believe that orthotic control of hindfoot deformities should be considered for those patients who require forefoot surgery as a combination of surgical and orthotic management may offer the best chance of success.

Adult↗
PubMed1990

Simultaneous or staged bilateral total knee replacements in rheumatoid arthritis. A prospective study.

In a prospective study of 100 knee arthroplasties in patients with rheumatoid arthritis, simultaneous bilateral surgery was compared with staged bilateral replacements. All patients had improved function following their operations but those who had staged surgery only achieved maximum benefit after the second knee had been replaced. The complication rate was no greater for simultaneous surgery and we therefore advocate the method for those patients who require bilateral replacements.

Activities of Daily Living↗
PubMed1990

Extending intramedullary rods in congenital pseudarthrosis of the tibia.

Five patients with Boyd type II congenital pseudarthrosis of the tibia underwent excision of the pseudarthrosis and double onlay bone grafting. Stability was maintained by extending intramedullary rods. Clinical union was achieved in all cases at a mean of 8.6 months (range six to 11). The rods extended by 15.7% (range 2% to 31.4%) as growth occurred. One rod was removed because of infection and a vascularised free fibular graft was subsequently performed. The extending rods provided stability while union occurred and did not require revision as the legs grew. The rods can be removed easily and have not jeopardized further surgical options.

Bone Transplantation↗
PubMed1990

Bicondylar St. Georg sledge knee arthroplasty.

Fifty-three bicondylar St. Georg sledge knee arthroplasties in 44 patients were reviewed. These patients had a mean follow-up period of 5.9 years (range, three to ten years). Function was assessed using the d'Aubigné scale coupled with measurement of range of motion (ROM) and stability. Pain relief was substantial (75%), and functional ability improved commensurately. ROM improved from a preoperative average of 83 to a postoperative 123. Three (5.7%) arthroplasties failed and were subsequently revised, while three (6.8%) of the knees examined at review have static radiolucent lines at the tibial bone-cement interface. The remaining 44 knees examined (93.2%) showed no signs of impending failure and have sustained their functional result. The polyethylene tibial components are not metal backed, and it is of interest that bone-cement interface failure has been unusual. This operation is a somewhat exacting procedure, but with the correct choice of patient and technique, a predictable result can be expected.

Adult↗
PubMed1989

Abnormal foot pressures alone may not cause ulceration.

Both rheumatoid arthritis and diabetes have been associated with the development of abnormally high pressures under the feet, and ulceration has been considered to be a problem in both conditions. In order to examine further the relationship between high foot pressure, neurological abnormalities, and ulceration, we have studied two groups of patients: (a) 38 diabetic patients and (b) 37 patients with rheumatoid arthritis who had similar clinical abnormalities of the feet. Thirty-two percent of diabetic patients had a history of plantar ulceration compared with none of the rheumatoid group (p less than 0.01). However, the diabetic group had considerably more severe neuropathy (peroneal nerve motor conduction velocity 35.4 +/- 4.8 m s-1 vs 44.4 +/- 5.2 m s-1 (mean +/- SD), p less than 0.001; vibration perception threshold 33.5 +/- 13.4 vs 16.9 +/- 10.9, p less than 0.001), with a similar frequency of elevated plantar pressures (51% vs 61%, NS). These data emphasize the importance of the loss of sensory awareness in the pathogenesis of diabetic foot ulceration, and suggest that high pressure alone is not a direct cause of ulceration.

Arthritis, Rheumatoid↗
PubMed1989

The role of expanding intramedullary rods in osteogenesis imperfecta.

We report the results of using 83 expanding intramedullary rods in 24 children with osteogenesis imperfecta after a mean follow-up of five years three months. In all, 62% of the rods have expanded after one primary operation. Thirty-four additional operations were necessary; 11 for the correction of rotation or angulation deformities and 23 for revision of the rod or T-piece. All these revisions were successful. Complications were more frequent in children who required very small rods. Problems with Bailey-Dubow rods led to the development of the Sheffield rod system; 17 bones treated with these rods are included in the series. Before surgery only eight of the 24 children were able to walk but at review 20 children were walking, 15 without walking aids. Elongating intramedullary rods should be available to all children with osteogenesis imperfecta as they improve walking capability, reduce the number of fractures, prevent deformity and allow integration of the child into society.

Adolescent↗