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Biomedical subjects

Jonathan P Braman

Publications and source records attributed to Jonathan P Braman.

5 recordsLinked to original sources
PubMed2006

Outcomes after arthroscopic rotator cuff repairs.

Recently, advances in arthroscopic techniques have allowed shoulder surgeons to perform fully arthroscopic repair of full-thickness tears. Outcome data have shown that improvement is inconsistent between studies. We performed a retrospective review of 105 consecutive patients who underwent arthroscopic rotator cuff repair from 1999 to 2002. Preoperative and postoperative evaluation consisted of a history, questionnaire, and examination to determine American Shoulder and Elbow Surgeons, Constant, and visual analog pain scores. Complete data were available for a minimum of 12 months (range, 12-45 months) for 71 patients. Increases in range of motion and outcome scores and associated reductions in visual analog scores were all significant. With massive tears, scores and pain were significantly improved. Arthroscopic rotator cuff repair reliably improves functional deficits and pain regardless of tear size. Smaller tears yield significant improvement in American Shoulder and Elbow Surgeons, Constant, and pain scores. Functional improvement was seen with massive tears, but gains in strength and motion were less dramatic.

Adult↗
PubMed2006

The outcome of resection shoulder arthroplasty for recalcitrant shoulder infections.

Postarthroplasty infection is a devastating complication. In some patients, virulent pathogens or poor health complicate reconstruction. Resection arthroplasty is a viable option in such cases. Seven patients with resection arthroplasty following infection after shoulder arthroplasty were reviewed retrospectively at an average 20- month follow-up (range, 12-41). Average time between the initial procedure and the first debridement was 59.5 months (4-151 months). The average number of debridements was 2.2 per patient (range, 1-4 procedures). There were no complications, no recurrence of deep infection, no nerve damage, and no fractures. All patients were able to reach the opposite axilla, their backpocket and perineum, and their mouth. All but 1 patient were satisfied with their result. No patient had a satisfactory outcome via Neer's criteria. Resection arthroplasty is a reasonable salvage option for patients who are not good candidates for prosthetic reimplantation. This yields patients who can reliably perform basic activities of daily living.

Aged↗
PubMed2006

Alterations in surface geometry in retrieved polyethylene glenoid component.

This study characterized and quantified the changes found in retrieved glenoid polyethylene components found at revision total shoulder arthroplasty (TSA). Twenty components obtained at revision TSA were evaluated, all from a system (Global, DePuy, Warsaw, IN) with a glenoid radius of curvature 3 mm greater than that of the humeral head. Laser surface scanning provided three-dimensional analysis of the surface of the glenoid component. Scans of unused components of similar sizes enabled determination of the changes occurring after implantation. Alterations in radius of curvature were noted in every glenoid. All showed loss of the balance stability angle (BSA, the maximal angle that the net humeral joint reaction force can make with the glenoid center line before the humeral head would dislocate) of at least 5 degrees in one or more directions. Increase in BSA in one direction was seen in 11 of the components. In five of these, the increase was associated with a reduction of the local radius to match that of the humeral component. Glenoid surface morphology and stability can be changed by in vivo use. While correlation with clinical instability in the patients from whom the implants were obtained was not possible, many of the observed changes in surface morphology are of sufficient magnitude to compromise the contribution of the glenoid surface to shoulder stability. Three patterns of wear were identified: "humeral" that showed loss of the mismatch between the humeral and glenoid radii of curvature (5 of 20 components), "diffuse" that showed broad surface irregularity (18 of 20), and "rim" wear with loss of the polyethylene rim of the component (14 of 20). More than one type of wear was possible within a single glenoid.

Arthroplasty, Replacement↗
PubMed2005

Articular cartilage adjacent to experimental defects is subject to atypical strains.

We tested the hypothesis that articular cartilage adjacent to experimental osteochondral defects is not subject to unusual strains under load. A 2.5-mm drill hole was made in the medial femoral condyle of 15 knees from 10 adult rabbits. Experimental joints were loaded with simulated quadriceps force, then frozen under load and preserved by freeze-substitution fixation. Deformation in the region of the defect was evaluated by scanning electron and light microscopy and compared with nondrilled and nonloaded control knees. To simulate blood clot, alginate was placed into some defects before loading. In loaded knees, articular cartilage at the edge of the drill hole was abnormally flattened and folded into the defect. Opposing tibial cartilage or meniscus intruded into the femoral defect beyond the cement line. Alginate did not prevent incursion of opposing cartilage. In this standard drill-hole model, the articular cartilage defect is occupied by the opposing surface when a joint is loaded. Any tissue growing or surgically implanted in the defect is subject to loading and displacement, therefore complicating attempts to characterize the healing or regenerative potential in similar drill-hole models. Deformation of cartilage at the defect edge suggests load concentration or increased compliance. Either phenomenon would contribute to subsequent degeneration of the cartilage adjacent to defects.

Animals↗