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John M Cuckler

Publications and source records attributed to John M Cuckler.

16 recordsLinked to original sources
PubMed2006

The optimal metal-metal arthroplasty is still a total hip arthroplasty: in the affirmative.

Metal-metal hip resurfacing offers the advantage of conservation of femoral bone stock. In addition, the implant may offer enhanced resistance to dislocation in comparison with conventional total hip arthroplasty (THA). However, early and intermediate results of the procedure do not exceed those of conventional THA. The learning curve is steep for the procedure, and there are biomechanical and anatomic limitations to resurfacing that limit the applicability of the procedure. Although there will undoubtedly be a place for hip resurfacing in the armamentarium of the reconstructive hip resurfacing, it cannot be argued at this time that the optimal metal-metal hip arthroplasty is a hip resurfacing. Conventional metal-metal THA remains the "gold standard" at this time.

Arthroplasty, Replacement, Hip↗
PubMed2005

The infected total knee: management options.

The management of infection after total knee arthroplasty depends on the chronicity of the infection, host factors, and sensitivity of the infecting bacteria. Two-stage salvage consisting of removal of implants and cement, placement of an antibiotic spacer, and appropriate intravenous antibiotic therapy followed by reimplantation with an antibiotic-impregnated cement appears to be the predominant approach to managing this complication. The use of articulated spacers consisting of the sterilized femoral and polyethylene components with antibiotic cement allows maintenance of motion and bone stock. This report details the author's experience with 44 infected knee arthroplasties.

Adult↗
PubMed2005

The rationale for metal-on-metal total hip arthroplasty.

Metal-on-metal total hip arthroplasty has the longest clinical history of any of the currently used articular couples. Long-term followup of what are now considered suboptimal designs (eg, McKee Farrar, Ring, Sivash) has produced a wealth of knowledge regarding the safety and efficacy of this articular combination. Retrieval analysis of metal-on-metal total hip arthroplasty articular couples has shown wear between 1 and 5 microns per year after initial wear-in, in comparison with 100 to 200 microns per year associated with metal-on-polyethylene wear. The constituent metal ions released through wear of the metal-on-metal total hip arthroplasty are excreted primarily in the urine; serum levels have been 3 to 5 times higher in patients who have had metal-on-metal total hip arthroplasties than in control subjects. No adverse physiologic effects have been identified in the long-term followup of patients exposed to cobalt-chromium implants. The clinical results of metal-on-metal total hip arthroplasties equal or exceed those of conventional articular couples and rarely are associated with osteolysis compared with conventional couples. Additional advantages of the metal-on-metal combination are the ability to use larger-diameter femoral heads for enhanced stability and the absence of concern over possible fracture of the articular components. The long-term experiences with metal-on-metal total hip arthroplasty make this combination of implant material the conservative choice for success.

Arthroplasty, Replacement, Hip↗
PubMed2005

Limb length and stability in total hip replacement.

Limb-length restoration and maintenance during THR is the result of careful preoperative assessment and planning. Intraoperative objective measurement of limb length is critical to avoid over-lengthening. Stability of the reconstructed hip is the result of a combination of proper implant position, proper soft-tissue tension, component design, and patient education.

Arthroplasty, Replacement, Hip↗
PubMed2004

Bone loss in total knee arthroplasty: graft augment and options.

The alternatives available for management of bone defects in total knee arthroplasty include prosthetic augments, autograft, allograft, and the use of bone cement. The selection of the augment technique should be based on the defect size, the patient age and life expectancy, and an assessment of the documented clinical results of each method. Prosthetic augments will address the vast majority of defects. The use of allograft is primarily indicated in the setting of major bone loss in revision knee arthroplasty, whereas the use of autograft is appropriate in the management of small defects in primary arthroplasty. Bone cement can be used for small defects if the stability of the implant is not compromised by the defect.

Arthroplasty, Replacement, Knee↗
PubMed2004

Mid-term results of a polyethylene-free metal-on-metal articulation.

Beginning in December 1995, 193 patients (195 hips) were enrolled into this prospective, randomized, controlled multicenter investigational device exemption study. Ninety-eight patients (99 hips) with 46 polyethylene liners and 53 metal liners had minimum 5-year follow-up (mean, 5.7 years). Average follow-up, Harris hip score improvement, and radiographic analysis were not statistically different between groups. No stress shielding or osteolysis was observed in either group. Three polyethylene liners and no metal liners had acetabular radiolucencies <1 mm in 1 or more zones. There have been no device-related complications, no acetabular revisions performed, and none pending in either group. Based on these mid-term results, the authors conclude that a metal-on-metal articulation represents a viable alternative in young, high-demand, active patients.

Arthroplasty, Replacement, Hip↗
PubMed2004

Large versus small femoral heads in metal-on-metal total hip arthroplasty.

The recent resurgence of metal-on-metal total hip arthroplasty has afforded the surgeon new options in femoral head diameters that were not previously available. Reduction in the risk for dislocation and potential improvements in articular wear are the obvious advantages of large-diameter femoral heads. Total hips with larger-diameter femoral heads are more resistant to dislocation. The clinical experience with 616 38 mm diameter femoral heads showed no dislocations within the first 3 months after surgery, compared with 2.5% of 78 patients receiving 28 mm diameter femoral heads with otherwise identical components. Use of larger-diameter femoral heads appears to have the potential to substantially reduce the early risk of dislocation of the prosthetic hip arthroplasty.

Arthroplasty, Replacement, Hip↗
PubMed2004

Outcome of hemiresurfacing in osteonecrosis of the femoral head.

Hemiresurfacing of the femoral head for treatment of osteonecrosis has been proposed as a reasonable alternative to total hip arthroplasty. The results of 59 patients with Ficat Stage III osteonecrosis done by a single surgeon are reviewed. At an average followup of 4.5 years, 16 patients were considered failures because of conversion to total hip arthroplasty or considerable groin pain requiring medication. Failure did not correlate with age, body mass index, preoperative length of symptoms, acetabular articular cartilage status at the time of surgery, or cause of the underlying disease. The only factor associated with failure was a lower preoperative Harris hip score. Conversion of the failed implants to total hip arthroplasty was straightforward, confirming the conservative nature of the procedure. However, pain relief and recovery after resurfacing are less reliable than that associated with total hip arthroplasty. This procedure may be appropriate for patients younger than 30 years, given the ease of conversion to THR if failure occurs. The patient should be counseled regarding expectations.

Adult↗
PubMed2003

Polyethylene damage on the nonarticular surface of modular total knee prostheses.

Modular tibial implants submitted for retrieval analysis were examined for evidence of cold flow, wear, or polyethylene failure. All retrieved components showed areas of cold flow and wear. Significant damage, defined as pitting, gouging, or delamination was observed in 77% of the retrieved implants. Cold flow deformation commonly was observed at the junction of the polyethylene and locking mechanisms or junction of the polyethylene and the edge of the tibial tray. Control implants did not show such areas of damage. Clinical factors such as age, activity status, length of implantation, limb alignment before revision, and thickness of the tibial insert did not correlate with backside wear. No association was found between polyethylene thickness, time of implantation, limb or prosthesis alignment, or activity status or weight of the patient.

Adult↗
PubMed2002

Management strategies for acetabular defects in revision total hip arthroplasty.

The management of failed acetabular implants in total hip arthroplasty revision surgery requires an algorithm for intraoperative decisions regarding technique and implant selection. When > or = 50% of the acetabular host-bone is intact and stable, a press-fit ingrowth socket offers a reliable solution. In the presence of peripheral, central, or combined defects, a reconstruction ring with compacted cancellous allograft is advised.

Acetabulum↗