Biomedical subjects

Javad Parvizi

Publications and source records attributed to Javad Parvizi.

At least 55 records · Page 3Linked to original sources

PubMed2005

Minimally invasive total hip arthroplasty: internet claims made by members of the Hip Society.

We searched the Internet for Web sites related to 106 members of the Hip Society. Web sites (private and/or hospital affiliated) for each surgeon were evaluated for the term "minimally invasive total hip replacement" and its related names. One hundred two of the 106 Hip Society members (96%) had Web sites. Of the 102 Web sites, eight Web sites had links to multiple members of the Hip Society, resulting in 94 distinct sites. Nineteen percent (19 of 102 members) of Hip Society members made reference to minimally invasive hip surgery. 11% (10 of 94 sites) of Web sites included references to minimally invasive hip surgery. When the terms fast or quicker recovery were evaluated, 14% (14 of 102 members) of surgeons used these terms. There were references to these terms on 6% (six of 94 sites) of the members' Web sites. Two incision techniques were discussed by only 10% (10 of 102 members) of members, and reported on 4% (four of 94 sites) of Web sites. In contrast, only 26% (five of 19 members) of Hip Society members and 30% (three of 10 sites) of Web sites reported the risks. Although minimally invasive hip arthroplasty frequently is discussed and advertised by some surgeons, only a small percentage of Hip Society members actually promote or make claims to these techniques on their Web sites.

Arthroplasty, Replacement, Hip↗

PubMed2005

Alternative bearing surfaces in total hip arthroplasty.

Total hip arthroplasty continues to be one of the most effective surgical procedures currently available. The longevity of this otherwise very successful procedure is compromised by the wear of the bearing surface. In recent years, great advances have been made in the design of bearing surfaces that poise to offer extended performance to these artificial joints. The purpose of this review is to discuss the recent technologic advances in bearing surfaces and offer an insight to the potential benefits and concerns with the alternative bearing surfaces.

Arthroplasty, Replacement, Hip↗

PubMed2005

The role of patient restrictions in reducing the prevalence of early dislocation following total hip arthroplasty. A randomized, prospective study.

BACKGROUND: It is currently unknown whether functional restrictions following total hip arthroplasty can reduce the prevalence of early postoperative dislocation. Our hypothesis was that dislocation was more likely to occur in patients who were not placed on these restrictions. METHODS: We performed a prospective, randomized study to evaluate the role of postoperative functional restrictions on the prevalence of dislocation following uncemented total hip arthroplasty through an anterolateral approach. Of the 630 eligible consecutive patients, 265 patients (303 hips) consented to be randomized into one of two groups (the "restricted" group or the "unrestricted" group). The patients in both groups were asked to limit the range of motion of the hip to <90 degrees of flexion and 45 degrees of external and internal rotation and to avoid adduction for the first six weeks after the procedure. The patients in the restricted group were instructed to comply with additional hip precautions during the first six weeks postoperatively. Specifically, these patients were managed with the placement of an abduction pillow in the operating room before bed transfer and used pillows to maintain abduction while in bed; used elevated toilet seats and elevated chairs in the hospital, in the rehabilitation facility, and at home; and were prevented from sleeping on the side, from driving, and from being a passenger in an automobile. All patients were followed for a minimum of six months postoperatively. RESULTS: There was one dislocation in the entire cohort (prevalence, 0.33%). This dislocation occurred in a patient in the restricted group during transfer from the operating table to a bed with an abduction pillow in place. Patients in the unrestricted group were found to return to side-sleeping sooner (p < 0.001), to ride in automobiles more often (p < 0.026), to drive automobiles more often (p < 0.001), to return to work sooner (p < 0.001), and to have a higher level of satisfaction with the pace of their recovery (p < 0.001) than those in the restricted group. There was an additional expenditure of approximately $655 per patient in the restricted group. CONCLUSIONS: Total hip arthroplasty through an anterolateral approach is likely to be associated with a low dislocation rate. Removal of several restrictions did not increase the prevalence of dislocation following primary hip arthroplasty at our institution. However, it did promote substantially lower costs and was associated with a higher level of patient satisfaction as patients achieved a faster return to daily functions in the early postoperative period.

Adolescent↗

PubMed2005

Proximal femoral replacement for the treatment of periprosthetic fractures.

BACKGROUND: A periprosthetic fracture around the femoral component is a rare but potentially problematic complication after total hip arthroplasty. Reconstruction can be challenging, especially when severe bone stock deficiency is encountered. Proximal femoral replacement is one method of treating the severely deficient proximal part of the femur. The present report describes the outcomes of revision total hip arthroplasty with use of a proximal femoral replacement in a cohort of patients who had a Vancouver type-B3 periprosthetic fracture. METHODS: With use of a computerized institutional database, all patients in whom a Vancouver type-B3 fracture (characterized by severe proximal bone deficiency and a loose femoral stem) had been treated with a proximal femoral replacement were identified. A modular femoral replacement with proximal porous coating had been used in all cases. The twenty-one patients who were identified had had a mean age of 78.3 years (range, fifty-two to ninety years) at the time of the index operation. The clinical and radiographic records of these patients were reviewed. RESULTS: At the time of the latest follow-up (mean, 3.2 years), all but one of the patients were able to walk and had minimal to no pain. Complications included persistent wound drainage that was treated with incision and drainage (two hips), dislocation (two hips), refracture of the femur distal to the stem (one hip), and acetabular cage failure (one hip). CONCLUSIONS: Despite a relatively high complication rate, we believe that proximal femoral replacement is a viable option for the treatment of periprosthetic fractures in older patients with severe bone deficiency. If a proximal femoral replacement is used, the stability of the hip must be tested diligently intraoperatively and a constrained acetabular liner should be utilized if instability is encountered. In order to enhance the bone stock, the proximal part of the femur, however poor in quality, should be retained for reapproximation onto the implant.

Aged↗

PubMed2004

Primary total hip arthroplasty with an uncemented femoral component: a long-term study of the Taperloc stem.

The purpose of the current study was to evaluate the long-term result of a tapered, uncemented femoral component. We retrospectively reviewed the clinical and radiographic records of 121 patients (129 hips) who underwent primary total hip arthroplasty with the use of the Taperloc uncemented stem. Follow-up averaged 11 years (range, 6-15 years). The mean Harris Hip Score at the latest follow-up was 92.1. Thigh pain was reported in 5 patients (3.6%). One stem was revised at 6 years because of severe proximal femoral osteolysis. There was no evidence of radiographic subsidence or loosening around any stems. The overall medium- to long-term outcome of the Taperloc stem is excellent, with a low revision rate and high patient satisfaction.

Adult↗

PubMed2004

Fifteen-year clinical survivorship of Harris-Galante total hip arthroplasty.

We studied the long-term outcome of uncemented total hip arthroplasty using HG-I components in 90 hips (80 patients) with an average age of 57.5 years who were operated on between 1984 and 1986 at our institution. Average follow-up was 14.9 years, and no patient was lost to follow-up. Hip scores improved significantly, and there was clinical and radiographic evidence of bony ingrowth on the acetabular components in all patients. There were 11 revisions in the study population for reasons related to failure of the femoral component (8 hips), acetabular liner dissociation (2 hips), and deep infection (1 hip). At the latest follow-up, 3 femoral components were determined to be loose. No acetabular component was revised for aseptic loosening. In addition to the revisions, there were 2 reoperations, 1 for psoas tendon release, and 1 for excision of heterotopic ossification. Thus, the survivorship free of revision and free of mechanical failure for the acetabular component at 15 years was 95.7% (95% confidence interval [CI], 0.89-1.0) and 91.9% (95% CI, 0.83-0.98), respectively. The survivorship at 15 years for the femoral component was 86.8% (95% CI, 0.78-0.95) free of revision and 82.0% (95% CI, 0.71-0.92) free of mechanical failure.

Adult↗

PubMed2004

Isolated acetabular polyethylene exchange through the anterolateral approach.

Isolated exchange of an acetabular liner, in the presence of a well-fixed acetabular component, has become an established method for the management of polyethylene wear. Various experienced adult-reconstruction surgeons have noted a high incidence of instability following isolated liner exchange. We report the results of isolated liner exchange in 35 patients with polyethylene wear and osteolysis (16 patients) or polyethylene wear and instability (19 patients) with a minimum follow-up of 2 years. Isolated liner exchange was performed through an anterolateral approach in all cases. Postoperative dislocation occurred in 2 of the 35 patients (6%), both with polyethylene wear and osteolysis. Isolated liner exchange was successful in addressing instability in all 19 patients who presented with polyethylene wear and dislocation. Isolated acetabular liner exchange performed through an anterolateral approach carries an acceptable dislocation rate.

Acetabulum↗

PubMed2004

Relationship between surgical volume and early outcomes of total hip arthroplasty: do results continue to get better?

This retrospective study explored the relationship between the volume of total hip arthroplasties (THA) and postoperative mortality and early complications from a single institution. One thousand hip arthroplasties in 932 patients were identified during a 1-year period, which included 786 primary and 214 revision hip arthroplasties. The postoperative 6-month combined medical and orthopedic complication rate for primary and revision THA was 7.9% and 16.5%, respectively. The 6-month mortality rate for the overall group was 0.5% (5 deaths), for the primary hips was 0.4% (3 deaths), and for the revision hip was 0.9% (2 deaths). The mortality and complication rates of many surgical procedures, including joint arthroplasties, are inversely related to hospital and surgical volume. The reduction in complication rate, however, approaches a plateau and does not improve regardless of an increase in the surgical and hospital volume.

Adult↗

PubMed2004

Metal-on-metal versus metal-on-polyethylene bearings in total hip arthroplasty: a matched case-control study.

This case-control study was performed to investigate the hypothesis that metal-on-metal (M-M) bearings reduce the risk of aseptic component loosening when compared with metal-on-polyethylene (M-PE) bearings. Cases were identified from a computerized joint database as patients who had received a primary total hip arthroplasty using an M-M or M-PE bearing and had documented revision or radiographic loosening of the stem or cup. Multiple controls were matched to each case for gender, age, diagnosis, hospital, operation date, follow-up, stem type, and cup design. Odds ratios were determined to identify the risk of component loosening for either bearing surface. In all, 505 cases and 1,605 controls were identified. M-M bearings demonstrated a lower risk of aseptic stem and/or cup loosening than M-PE bearings; however, this was not statistically significant.

Aged↗

PubMed2004

Proximal femoral replacements with megaprostheses.

The exact role of proximal femoral replacement (megaprosthesis) in revision hip surgery is unclear. During the past decade remarkable advances in the field of revision hip reconstruction have been made including the availability of allograft cancellous and cortical bone. With the increased use of cortical strut grafts to augment host bone, the indications for the use of megaprostheses have narrowed. Currently, we reserve the use of megaprostheses for elderly or sedentary patients with massive proximal femoral bone loss that cannot be reconstructed by other reconstructive procedures. This may include failed total hip arthroplasty (THA), nonunion of the proximal femur with multiple failed attempts at osteosynthesis, and hip salvage after a failed resection arthroplasty.

Arthroplasty, Replacement, Hip↗

PubMed2004

Bilateral spontaneous periacetabular fracture: an unusual complication of multiple sclerosis.

We describe an unusual case of a 43-year-old woman who had developed bilateral spontaneous periacetabular fractures secondary to severe myoclonic contractions. The absence of antecedent history of trauma and detection of muscular spasticity at presentation prompted neurologic investigations that led to the diagnosis of multiple sclerosis in this patient. The fractures were treated successfully by open reduction and internal fixation initially. Since fracture reduction was delayed for almost 1 year, a special distraction frame had to be used. Deterioration in the medical condition of the patient with return of severe spasticity caused a dramatic failure of the fixation on one side 2 years later. This case report confirms that fractures, usually requiring high-impact trauma, can and do develop spontaneously in patients with sustained myoclonic contractions, and these fractures can be the presenting indication of an underlying neuromuscular disorder.

Acetabulum↗

PubMed2004

Previous Bernese periacetabular osteotomy does not compromise the results of total hip arthroplasty.

It is not known if a previous periacetabular osteotomy poses technical difficulties and may increase the incidence of complications after total hip arthroplasty. The records of 41 patients who had THA after periacetabular osteotomy were evaluated. Followup averaged 6.9 years (range, 2-14 years). The average interval from osteotomy to total hip arthroplasty was 6.3 years (range, 4 months-14 years). Total hip arthroplasty provided significant relief of pain and improvement in function for all the patients. The acetabulum was judged to be retroverted in 23 patients and special attention to component positioning was needed. An abnormal proximal femoral anatomy secondary to previous intertrochanteric osteotomy or underlying dysplasia, or trochanteric overgrowth necessitated the use of trochanteric osteotomy for exposure in 24 patients. There were an acceptable number of complications and two revisions in the series. Aseptic loosening of the femoral component in one patient (one hip) and acetabular component in another patient (one hip) were the reasons for the two revisions. Total hip arthroplasty with technical consideration and careful evaluation of the acetabular version and relocated teardrop can be done safely in patients with a previous periacetabular osteotomy and should provide excellent results.

Acetabulum↗

PubMed2004

Increased intraarticular pressure reduces blood flow to the femoral head.

Hemarthrosis leading to increased intracapsular pressure after an undisplaced femoral neck fracture is suspected to impair blood flow to the femoral head and may lead to osteonecrosis. We hypothesized that an increase of intraarticular pressure would reversibly decrease the blood flow to the femoral head. Eleven patients having surgical dislocations for treatment of femoroacetabular impingement were included in this study. Saline was injected into the intact intracapsular space while the blood flow to the femoral head was recorded using laser Doppler flowmetry. Injection of saline resulted in an increase in the intracapsular pressure. The injected volume of normal saline until disappearance of the pulsatile signal was on average 20 mL (range, 10-35 mL) with an average intraarticular pressure of 58 mm Hg (range, 25-88 mm Hg). Aspiration of the joint resulted in a return of the pulsatile flow. Hemarthrosis after undisplaced intracapsular fractures of the femoral neck are likely to cause an increase in intracapsular pressure. Decompression of the hematoma to reduce the intracapsular pressure is strongly advocated to optimize blood flow to the femoral head in acute fractures.

Femur Head↗

PubMed2004

Frank Stinchfield Award. Titanium surface with biologic activity against infection.

Despite immense improvements, periprosthetic infection continues to compromise the result of otherwise successful joint arthroplasty. There are various limitations in the treatment of periprosthetic infection, the most important of which is the inability to deliver antibiotics to the local tissue without the need for intravenous administration. We have developed a novel route to covalently tether vancomycin to a metal (titanium) surface, which showed effective bactericidal activity because of a vancomycin coupling. The chemistry of tethering does not affect the biological activity of the biofactors that are attached to the metal surface. This technology holds great promise for the manufacturing of "smart" implants that can be self protective against periprosthetic infection, or can be used for the treatment of periprosthetic infections when they occur.

Awards and Prizes↗

PubMed2004

Total hip arthroplasty in patients with dwarfism.

BACKGROUND: Patients with short stature and osseous deformities resulting from osteochondrodysplasia frequently have premature development of advanced degenerative disease of the hip and thus may require total hip arthroplasty. The outcome of total hip arthroplasty in this group of young patients is unknown. In this study, we evaluated the long-term clinical and radiographic outcomes of total hip arthroplasty in patients with osteochondrodysplasia. METHODS: Between 1971 and 1997, sixty-two total hip arthroplasties were performed at our institution in thirty-seven patients with severe osteoarthritis secondary to osteochondrodysplasia. There were seventeen female patients and twenty male patients. Their average height was 142 cm, and their average age at the time of the index arthroplasty was thirty-seven years. The patients were followed clinically with use of the Harris hip score for a mean of 12.8 years, and they were followed radiographically for a mean of 11.5 years. RESULTS: The mean Harris hip score improved significantly (p < 0.0001), from 57 points preoperatively to 87 points at the time of the latest follow-up. Of the sixty hips available for follow-up, eighteen (30%) had required revision arthroplasty: fourteen required it because of aseptic loosening of one or both components; two, because of deep infection; one, because of periprosthetic fracture; and one, because of extensive osteolysis. There were two additional periprosthetic femoral fractures, which were treated with open reduction and internal fixation with retention of the components. The majority of patients had other functionally limiting conditions, such as spinal deformities, in addition to the degenerative arthritis. CONCLUSIONS: There was a high prevalence of complications, periprosthetic fractures, and mechanical failure in these patients with osteochondrodysplasia who underwent total hip arthroplasty. Young age, severe deformity, and multiple joint involvement may in part explain these findings. Nonetheless, total hip arthroplasty proved to be reliable for alleviating pain and improving function in patients with advanced symptomatic arthritis of the hip secondary to osteochondrodysplasia.

Adolescent↗

PubMed2004

Total knee arthroplasty following proximal tibial osteotomy: risk factors for failure.

BACKGROUND: The results of proximal tibial osteotomy are known to deteriorate over time, with the majority of patients eventually requiring total knee arthroplasty. The outcome of total knee arthroplasty in patients who have had a proximal tibial osteotomy, compared with that of routine primary total knee arthroplasty, remains controversial. The purpose of the present study was to evaluate the long-term clinical and radiographic outcome of total knee arthroplasty in patients who had undergone a previous proximal tibial osteotomy and to identify the risk factors that may result in an inferior outcome. METHODS: Between 1980 and 1990, 166 cemented condylar total knee prostheses were implanted in 118 patients who had had a previous proximal tibial osteotomy for the treatment of osteoarthritis. The study group included seventy-seven men and forty-one women who had a mean age of 69.1 years at the time of knee arthroplasty. The average interval between the osteotomy and the total knee arthroplasty was 8.6 years. The average duration of clinical follow-up was 15.1 years, and the average duration of radiographic follow-up was 9.2 years. RESULTS: The mean Knee Society pain score improved from 34.5 to 82.9 points, and the mean function score improved from 44.6 to 88.1 points. There was also a substantial improvement in the mean arc of motion. Thirteen knees (8%) were revised at a mean of 5.9 years. At the time of the final follow-up, progressive complete radiolucent lines indicating a loose prosthesis were present around seventeen tibial components and seven femoral components. CONCLUSIONS: There was a very high rate of radiographic evidence of loosening. Male gender, increased weight, young age at the time of total knee arthroplasty, coronal laxity, and preoperative limb malalignment were identified as risk factors for early failure. Despite these findings, total knee arthroplasty can provide reliable and durable pain relief and improvement in function for patients who have had a previous proximal tibial osteotomy. LEVEL OF EVIDENCE: Prognostic study. Level II-1 (retrospective study). See Instructions to Authors for a complete description of levels of evidence.

Age Factors↗

PubMed2004

Prospective matched-pair analysis of hydroxyapatite-coated and uncoated femoral stems in total hip arthroplasty. A concise follow-up of a previous report.

This prospective study was performed to examine the results of total hip arthroplasty with a tapered uncemented femoral component with and without hydroxyapatite coating in a matched-pair group of patients. Since our original publication in 1996, no femoral component was revised in either group. After a mean clinical and radiographic follow-up of 9.8 years, all femoral components were stable, with no evidence of progressive radiolucency or osteolysis. Ten acetabular components were revised because of aseptic loosening and wear. Our study demonstrated no clinical or radiographic advantage, during the first decade after implantation, to the use of hydroxyapatite on this design of femoral component in primary total hip arthroplasty.

Aged↗

PubMed2004

Thirty-day mortality following hip arthroplasty for acute fracture.

BACKGROUND: Hip fractures are associated with a substantial mortality rate. Previous reports on perioperative mortality associated with hip arthroplasty for the treatment of acute fracture have not documented demographic and surgical characteristics that increase the likelihood of death. The purpose of the present study was to determine the prevalence of, and associated risk factors for, perioperative death following hip arthroplasty for the treatment of acute fracture. METHODS: Data were compiled from the computerized total joint registry at a single institution to determine the mortality rate following hip arthroplasty according to age, gender, diagnosis, implant type, and fixation mode. A review of this database revealed that 7774 consecutive patients had undergone hip arthroplasty for the treatment of an acute fracture between 1969 and 1997. The medical records of all patients who had died within thirty days after hip arthroplasty were reviewed retrospectively. RESULTS: The overall mortality rate within thirty days after hip arthroplasty for the treatment of an acute fracture was 2.4% (186 of 7774), yet notable variations in the mortality rate were seen within clinical subgroups. The thirty-day mortality rate was significantly higher for patients who had received a cemented implant, female patients, elderly patients, patients with cardiorespiratory comorbidities, and patients with intertrochanteric fractures. With the numbers available, there was no significant difference in mortality between patients who had been managed with total hip arthroplasty and those who had been managed with hemiarthroplasty. CONCLUSIONS: Hip arthroplasty for the diagnosis of acute fracture is associated with a nearly tenfold higher rate of perioperative mortality compared with elective hip arthroplasty. Medical optimization, appropriate choice of implants, and vigilant intraoperative management of these patients are essential.

Acute Disease↗