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Joseph C McCarthy

Publications and source records attributed to Joseph C McCarthy.

11 recordsLinked to original sources
PubMed2006

Osteonecrosis of the knee after laser or radiofrequency-assisted arthroscopy: treatment with minimally invasive knee arthroplasty.

BACKGROUND: Osteonecrosis of the knee after various arthroscopic procedures associated with the use of laser or radiofrequency devices has been described in a few case reports. The purpose of this study was to report on a series of nineteen patients with osteonecrosis of the knee after arthroscopic procedures. A literature search was done to compare this series of patients to previously reported cases. In addition, we analyzed the outcome after treatment with minimally invasive knee arthroplasty. METHODS: We studied patients who had development of osteonecrosis of the knee after a routine arthroscopic procedure. Preoperative and postoperative clinical notes, radiographs, and magnetic resonance images of patients were analyzed. Only those patients with no evidence of osteonecrosis on preoperative magnetic resonance imaging who later had development of osteonecrosis and subsequently required a knee arthroplasty were included. We conducted a search of the current literature to compare the results seen in our patient population with those seen in other patients with this entity. Patients were followed both clinically and radiographically for a mean of sixty-two months. RESULTS: A total of nineteen patients met the inclusion criteria. There were fourteen women and five men with a mean age of sixty-nine years. Six patients underwent an arthroscopy with associated holmium or yttrium-aluminum-garnet laser treatment, ten patients had associated radiofrequency treatment, and three patients had microfracture surgery. Subsequent arthroplasty procedures included four unicompartmental knee arthroplasties and fifteen tricompartmental knee arthroplasties. At the time of final follow-up, the mean Knee Society objective score was 95 points. CONCLUSIONS: Arthroscopic procedures may play a role in the development of osteonecrosis of the knee. To our knowledge, this is the largest series of patients to have development of this condition after arthroscopy with associated laser, radiofrequency, or microfracture surgery. The midterm results of knee arthroplasty in this unique patient population are comparable with those of patients undergoing knee arthroplasty for osteoarthritis of the knee. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors on jbjs.org for a complete description of levels of evidence.

Aged↗
PubMed2006

Hip arthroscopy: indications, outcomes, and complications.

Hip arthroscopy is technically demanding, with a steep learning curve, and requires special distraction tools and operating equipment. Access to the hip joint is difficult because of the resistance to distraction resulting from the large muscular envelope, the strength of the iliofemoral ligament, and the negative intra-articular pressure. This operation should not be done without specific education in its methods.

Arthroscopy↗
PubMed2005

Constrained acetabular components in complex revision total hip arthroplasty.

UNLABELLED: We retrospectively reviewed 39 consecutive hips in 38 patients to examine the outcome of acetabular fixation and stability in patients with the tripolar constrained acetabular component who had complex revision surgery at 2 to 5 years of followup. Preoperative indications included recurrent dislocation, loose acetabular component with instability, migrated bipolar, resection arthroplasty conversions, and primary arthroplasty. Postoperative radiographs were reviewed for radiolucencies, loosening, migration, or breakage. The patients' average age was 65 years (range, 44-83 years). Thirty-five of the 39 acetabular components (91%) are well fixed and bony ingrown. There were no dislocations. One patient was involved in an motor vehicle accident 1 year postoperatively and sustained a fracture of the ilium and a 2 mm radiolucency about the component which is now stable. Three patients had acetabular revisions. Two patients were revised to a tripolar cemented into a cage and are doing well. The tripolar constrained acetabular component offers reliable fixation and joint stability in patients at high risk for dislocation in this short term followup. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series). See the Guidelines for Authors for s complete description of levels of evidence.

Acetabulum↗
PubMed2005

Hip arthroscopy: indications and technical pearls.

UNLABELLED: Our purpose is to describe the evolving indications, technical pearls and contraindications for hip arthroscopy. Although traditional clinical and radiographic measures may identify structural abnormalities or fracture or the hip, recently developed arthroscopic access to the joint has provided new ways of viewing lesions of the labrum, chondral surfaces, and synovium that previously were unrecognized. Development of hip-specific distraction equipment and instruments has allowed treatment of many conditions, especially loose bodies and labral and chondral injuries. In the senior author's experience of more than 2000 hip arthroscopies, several key issues have been resolved. The procedure can be done safely and reproducibly. It can be done with minimal morbidity, and it can be accomplished in a cost-efficient manner as outpatient surgery. Symptom relief and functional improvement can be achieved. Further research is necessary to determine long-term outcomes. LEVEL OF EVIDENCE: Level V (expert opinion). See the Guidelines for Authors for a complete description of levels of evidence.

Ambulatory Surgical Procedures↗
PubMed2004

Arthroscopic intervention in early hip disease.

Advancement in diagnostic and therapeutic applications for hip arthroscopy have dispelled previous myths about early hip disease. Arthroscopic findings have established the following facts: Acetabular labral tears do occur; acetabular chondral lesions do exist; tears are most frequently anterior and often associated with sudden twisting or pivoting motions; and labral tears often occur in association with articular cartilage lesions of the adjacent acetabulum or femoral head, and if present for years, contribute to the progression of delamination process of the chondral cartilage. Magnetic resonance arthrography represents an improvement over conventional magnetic resonance imaging, it does have limitations when compared with direct observation. Although indications for hip arthroscopy are constantly expanding, the most common indications include: labral tears, loose bodies, chondral flap lesions of the acetabular or femoral head, synovial chondromatosis, foreign body removal, and crystalline hip arthropathy (gout, pseudogout, and others). Contraindications include conditions that limit the potential for hip distraction such as joint ankylosis, dense heterotopic bone formation, considerable protrusio, or morbid obesity. Complication rates have been reported between 0.5 and 5%, most often related to distraction and include sciatic or femoral nerve palsy, avascular necrosis, and compartment syndrome. Transient peroneal or pudendal nerve effects and chondral scuffing have been associated with difficult or prolonged distraction. Meticulous consideration to patient positioning, distraction time and portal placement are essential. Judicious patient selection and diagnostic expertise are critical to successful outcomes. Candidates for hip arthroscopy should include only those patients with mechanical symptoms (catching, locking, or buckling) that have failed to respond to conservative therapy. The extent of articular cartilage involvement has the most direct relationship to surgical outcomes. Improvements in technique and instrumentation have made hip arthroscopy an efficacious way to diagnose and treat a variety of intra-articular problems.

Arthrography↗
PubMed2004

The diagnosis and treatment of labral and chondral injuries.

Hip arthroscopy is an excellent way to evaluate, diagnose, and treat acetabular labral and chondral lesions. It is minimally invasive and can be done on an outpatient basis. Candidates for hip arthroscopy will have functionally limiting symptoms and reproducible physical findings. Patients will often have mechanical symptoms such as clicking, catching, locking, or giving way. Symptoms may be preceded by a traumatic event such as a fall or twisting injury or may have an insidious onset. Radiographic studies are not sensitive enough to diagnose intra-articular hip pathology; however, contrast agents used in conjunction with CT and MRI may aid in the diagnosis. Therefore, a high level of clinical suspicion and prudent clinical judgment are warranted. A thorough knowledge of positioning and anatomic relationships to portal placement is necessary to prevent potential neurovascular complications from occurring during hip arthroscopy. Labral tears are the most common cause of mechanical hip symptoms. Tears occur anteriorly, and associated chondral lesions are common. The severity of the chondral lesion is highly correlated with the surgical outcome. The most frequently observed chondral lesion is the watershed lesion, which consists of a labral tear with separation of the labrum from the articular surface at the labral-cartilage junction. The difficulty in identifying these lesions as well as their effect on outcome provides a convincing rationale for arthroscopic hip surgery. Arthroscopic treatment of these tears involves judicious debridement back to a stable base while carefully preserving the capsular labral tissue. Eliminating the source of mechanical symptoms secondary to labral pathology should alleviate the patient's discomfort. Chondral defects are drilled or treated with a microfracture technique to enhance fibrocartilage formation. Patient outcomes are directly dependent on the stage or extent of the labral and chondral lesion.

Acetabulum↗
PubMed2004

Hip arthroscopy: when it is and when it is not indicated.

Problems that occur in the hip joint, such as a loose body or labral tear, can be treated arthroscopically or with conventional arthrotomy. Hip arthroscopy can facilitate both comprehensive access to and treatment of an evolving series of conditions that affect the hip joint. Candidates for hip arthroscopy should have reproducible symptoms and physical findings that limit function, and a history of mechanical symptoms. Following total hip replacement, when unexplained symptoms persist despite appropriate conservative treatment combined with a negative workup, arthroscopy can be valuable. Intra-articular third bodies often can be successfully removed arthroscopically. Arthroscopy can be valuable after trauma for evacuation of hematomas and removal of chondral loose bodies, and repair of labral injuries. Contraindications to arthroscopy include advanced osteoarthritis, osteonecrosis with femoral head collapse, an ankylosed joint, significant protrusio or grade III or IV heterotopic bone.

Arthroplasty, Replacement, Hip↗
PubMed2003

Hip arthroscopy: surgical approach, positioning, and distraction.

The hip is the most deeply recessed joint in the body making it difficult to access arthroscopically. However, for the patient with a symptomatic loose body or labral tear open techniques are less advantageous. It is for this reason that, however difficult, minimally-invasive approaches to the hip have been developed. Meticulous attention to proper positioning and portal placement is paramount for safe and successful arthroscopy of the hip. The current authors will review the seminal features of positioning and minimally-invasive surgical approaches to the hip.

Arthroscopy↗
PubMed2003

The nonarthritic hip score: reliable and validated.

The purpose of the current study was to assess the validity, internal consistency, and reproducibility of a short, self-administered hip score designed for use in younger patients with higher demands and expectations than older patients with degenerative joint disease. Validity and internal consistency was studied with 48 consecutive patients with a mean age of 33 years with intractable hip pain and normal plain radiographs. Reproducibility was assessed from data on an additional random sample of 17 patients with hip pain. The Pearson correlation coefficients were 0.82 and 0.59 between the nonarthritic hip score and the Harris hip score and Short Form-12, respectively showing validity. Cronbach's coefficient alpha measuring the internal consistency within each of the score's four domains ranged from 0.69 to 0.92. The test and retest reproducibility ranged from 0.87 to 0.95 for the four subsets and was 0.96 overall. This short, self-administered questionnaire regarding hip pain in young patients with increased activity demands and high treatment expectations is valid compared with previous measures of hip performance, is internally consistent, and is reproducible.

Adolescent↗
PubMed2002

Acetabular dysplasia: a paradigm of arthroscopic examination of chondral injuries.

The current authors show the value of arthroscopy in diagnosing labral and acetabular cartilage injury and examining the relationship between those injuries and acetabular dysplasia. Between 1989 and 2000, 170 hips in 163 patients with mild acetabular dysplasia or moderate dysplasia with joint preservation had arthroscopic evaluation. Surgical findings were classified by location and by severity of the chondral lesions of the femoral head, acetabulum, and labrum. Of the 170 hips with dysplasia, 122 had labral tears (72%) at the free-margin articular surface and 113 had anterior tears (66%). One hundred hips (59%) had anterior acetabular chondral lesions. Among the 113 patients who had anterior labral tears, 78 hips (69%) had anterior acetabular chondral defects, and 44 hips (39%) had anterior femoral head chondral lesions. Mild uncovering of the anterior femoral head subjects the labrum to increased load and potential susceptibility to tearing most frequently anteriorly. Labral tears may contribute to or can occur in association with articular cartilage lesions of the contiguous femoral head or acetabulum. The mechanism of injury is most likely hyperextension or torque of the hip or both. The findings in the current study support the concept that labral disruption frequently is a predecessor in the continuum of degenerative joint disease.

Acetabulum↗