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Biomedical subjects

K K Hansraj

Publications and source records attributed to K K Hansraj.

15 recordsLinked to original sources
PubMed2001

Decompressive surgery for typical lumbar spinal stenosis.

Between 1991 and 1992, 103 consecutive patients (average age, 65 years) underwent decompressive surgery for treatment of typical lumbar spinal stenosis. Clinical results at 1-year followup revealed that four patients had revision surgery. At 2- to 5-years followup, there were no additional revision surgeries. Two patients underwent revision surgery for a deep infection, and two underwent revision surgery for a superficial infection. Outcome results showed that 77 patients completed the questionnaire, 15 were lost to followup and 11 died. Postoperative results showed that 64 of 77 patients had no or mild pain, 72 of 77 patients stated that they were satisfied or somewhat satisfied with their overall results of surgery, and 73 of 77 were satisfied with pain relief. Younger patients had greater improvement in function and a greater reduction in severity scores. However, satisfaction was similar in both groups. Survivorship results (failure was revision surgery) showed at the end of 4 years, a patient had a 95% chance of not having revision surgery. Statistically, there was no association between outcome and cofactors such as scoliosis, spondylolisthesis, number of levels decompressed, discectomy, or smoking. Satisfaction rates for older patients were similar to patients younger than 65 years although physical function scores and severity scores were less.

Aged↗
PubMed2001

Decompression, fusion, and instrumentation surgery for complex lumbar spinal stenosis.

Between 1990 and 1993, 54 consecutive patients were treated with decompression, fusion and instrumentation surgery for complex lumbar spinal stenosis. The mean age of the patients was 60 years. The average followup was 39 months. Clinically, there was one deep wound infection, and three mechanical failures. There were two staged operations. There were three revision surgeries performed for mechanical reasons. Of the 47 patients who completed the questionnaire, 96% of patients were very satisfied or somewhat satisfied with the operation, 98% were satisfied with relief of pain, 94% were satisfied with their ability to walk, 89% were satisfied with their strength, and 94% were satisfied with balance. Survivorship analysis (failure endpoint was revision surgery) revealed that at the end of 4 years, the patient had a 92% chance of not undergoing revision surgery for any reason (mechanical and infectious), and a 94% chance of not undergoing revision surgery for mechanical reasons. Lumbar decompression, fusion, and instrumentation surgery seems to be efficacious in patients with complex lumbar spinal stenosis (associated previous lumbar spine operations with evidence of radiographic instability, radiographic evidence of junctional stenosis after surgery, radiographic evidence of instability, degenerative spondylolisthesis greater than Grade I with instability, if present, and degenerative scoliosis with a curve greater than 20 degrees).

Decompression, Surgical↗
PubMed2000

Nonoperative treatment for lumbar spinal stenosis. Clinical and outcome results and a 3-year survivorship analysis.

STUDY DESIGN: A cohort study of nonoperatively treated patients with lumbar spinal stenosis. OBJECTIVE: To assess the effectiveness of aggressive nonsurgical treatment for lumbar spinal stenosis. BACKGROUND DATA: While surgical treatment of lumbar spinal stenosis has been widely accepted, the natural history of this condition is poorly documented. Moreover, the effect of other available therapies is unclear. METHODS: Forty-nine patients meeting radiographic and clinical criteria for spinal stenosis underwent nonsurgical intervention consisting of therapeutic exercises, analgesics, and epidural steroid injections. Patients were followed for an average of 33 months. Outcome was assessed using a recently developed patient questionnaire for assessment of patients with lumbar spinal stenosis. Survival analysis was used to assess the probability of surgical intervention over the follow-up period. RESULTS: At 3 years following treatment, 9 of the 49 patients had undergone surgical intervention. Of the remaining 40 unoperated patients, it is reported that two suffered significant motor deterioration, one of whom still reported overall symptoms as mild improvement, and the other as definite worsening. Five of the 40 unoperated patients reported feeling overall symptoms as probably or definitely worse, 12 reported no change, 11 reported only mild improvement, and 12 reported sustained improvement. Twelve of the 40 unoperated patients also had none or only mild pain. CONCLUSIONS: The authors conclude that aggressive nonoperative treatment for spinal stenosis remains a reasonable option.

Aged↗
PubMed1997

Percutaneous (endoscopic) decompression discectomy for non-extruded cervical herniated nucleus pulposus.

In 1838, Key described the pathological findings of two cases of cord compression by "intervertebral substance." In the 1800s and early 1900s many cases of chondromas of the cervical spine were reported. In 1928 Stookey, described the clinical symptoms and anatomic location of cervical disk herniation. In 1934, Mixter and Barr documented four cervical disc protrusions. Before 1950, the standard approach to discs in this region was posteriorly with laminectomy. In the 1950s Bailey, Badgley, Cloward, Smith and Robinson popularized the anterior approach with interbody fusion. Hirsch in 1960, then Robertson in 1973, recommended cervical discectomy without fusion. Similar results were noted.

Journal Article↗
PubMed1997

Swanson metacarpophalangeal joint arthroplasty in patients with rheumatoid arthritis.

Between 1981 and 1991, 348 Swanson metacarpophalangeal replacements were implanted in patients with rheumatoid arthritis. There were 64 female and seven male patients. Both hands were reconstructed in 18 patients. Clinically, 170 implants were available for an average of 5.2 years (range, 2-10 years) followup. Severe synovitis was seen in 7% of metacarpophalangeal joints, moderate synovitis in 25%, slight synovitis in 17%, and synovitis was not present in 51%. Pain was found to be severe in 4% of the joints, moderate in 3%, slight in 39%, and not present in 54% of the joints. The average preoperative active arc of motion was 38 degrees, and the average postoperative arc of motion was 27 degrees. Eleven of 12 fractures found were revised. There were no infections. Functionally, of 58 patients assessed, 58 (100%) reported the ability to feed themselves, 55 (94%) to button clothes, and 54 (93%) to write. Quality radiographs were available in 144 joints. Eighty-four percent of implants showed sclerosis of bone and 8% showed resorption adjacent to the implant. Survivorship analysis revealed a 94% success rate at 5 years, 93% at 7 years, and 90% at 10 years using the end point of revision surgery.

Arthritis, Rheumatoid↗
PubMed1997

Swanson proximal interphalangeal joint arthroplasty in patients with rheumatoid arthritis.

One hundred thirty-eight Swanson proximal interphalangeal replacements were implanted in patients with rheumatoid arthritis, of which 99 implants were available for average 5.8 years followup. Pain was severe in 1%, moderate in 4%, slight in 28%, and not present in 67%. The average preoperative active arc of motion was 38 degrees, and postoperative 29 degrees. Ten fractures were found, and were revised. Of 45 patients assessed, 45 (100%) reported the ability to feed themselves, 43 (96%) to button their clothes, and 42 (93%) to write. There was sclerosis of bone around 78% of the implants and resorption adjacent to 12% of the implants. Survivorship analysis showed that 81% of implants were not revised at 9 years.

Activities of Daily Living↗
PubMed1995

Gunshot wound injuries. Frequency and cost analyses in south central Los Angeles.

Nine hundred fifty-two patients with gunshot wound injuries admitted between July 1, 1989 and June 30, 1990 in a level one trauma center in South Central Los Angeles were studied retrospectively. The authors attempted to define those periods that gunshot injuries were most likely to occur, to characterize the involved high-risk populations, and to estimate direct and indirect cost of care to society.

Adult↗
PubMed1995

Gunshot wounds to the elbow.

Gunshot wound injuries to the elbow are rare. This article presents the experience of the King/Drew Medical Center. Classification and management of these injuries are emphasized. An algorithm is presented.

Adult↗
PubMed1995

Efficacy of ceftriaxone versus cefazolin in the prophylactic management of extra-articular cortical violation of bone due to low-velocity gunshot wounds.

One hundred patients sustained gunshot wounds involving bone but not joint with a low-velocity bullet. Soft-tissue involvement was less than 1 cm at its greatest diameter. All patients were free from artery or nerve damage. No formal fixation of fracture was required. The results of the study suggest that patients need not be hospitalized longer than 2 days after an extra-articular, low-velocity gunshot wound that violates the cortex. In addition, through the use of long half-life antibiotics, such as ceftriaxone, the length of hospitalization may further be reduced to a day, while the potential for morbidity from infection is not increased.

Adult↗
PubMed1995

Gunshot wounds to the hand. The Martin Luther King, Jr, General Hospital experience.

This article is a retrospective review of patients who presented to Martin Luther King, Jr./Drew Medical Center with gunshot wounds and had either isolated or associated injuries to the hand. The following is an account of those injuries noting the location, soft-tissue or bony involvement, and interventional methods that were implemented in the treatment of these patients who resided primarily in South Central Los Angeles. Prompt evaluation and initiation of treatment is essential in the management of both high- and low-velocity gunshot wounds so as to decrease the potential morbidity that often follows. Society must also look at the prevalence of these injuries and address the underlying issues that often are the root of the acts of violence.

Adolescent↗
PubMed1993

Long-term results of the total condylar knee arthroplasty. A 15-year survivorship study.

This study reports the 15-year survivorship of 112 consecutive Total Condylar knee arthroplasties that have been followed since 1974. Two endpoints were chosen for survivorship: (1) Revision attributable to septic or aseptic loosening or malalignment. (2) Revision or roentgenographic evidence of component loosening. Life table analysis reveals a 94.1% clinical survivorship at 15 years, with an 90.9% survivorship when roentgenographic failures are included. There were five revisions: one for infection, one for instability, and three for tibial loosening. In addition, two tibiae and one patella were considered roentgenographically loose, but were not symptomatic. As of May 1992, 34 patients with 48 knees are known deceased, 15 knees are lost to follow-up evaluation, and 49 knees are available for clinical evaluation. Follow-up data was available on 62 knees for greater than 11 years. Ninety-two percent had good or excellent results, with 1.6% fair and 6.5% poor. Average range of motion was 99 degrees. The average Hospital for Special Surgery knee score was 85. Roentgenographic study revealed lucencies around 72% of tibiae, but only two components were loose. There was a correlation between body weight and the presence of radiolucencies, and patients who weighed more than 80 kg had the lowest survivorship at 15 years: 89.2% clinical survival and 70.6% clinical plus roentgenographic survival. Total Condylar knee arthroplasty has a 94.6% clinical survival at 15 years, with predictably good clinical results.

Adult↗
PubMed1989

Effect of posterior cruciate sacrifice on durability of the cement-bone interface. A nine-year survivorship study of 100 total condylar knee arthroplasties.

This article presents a survivorship analysis of the second conservative 100 primary total-condylar knee arthroplasties in 75 patients performed between 1979 and 1980, with a maximum follow-up of 9 years. With this type of knee arthroplasty, the posterior cruciate ligament is routinely sacrificed. Survivorship results revealed that 98.9 per cent of the knees had good outcome at 9 years of follow-up, using revision surgery for aseptic and septic loosening and radiographic evidence of global radiolucency or shift of the component as endpoint. Radiographic survivorship analysis showed well-fixed components in 87 per cent of implants, using endpoint criteria of appearance and progression of radiolucency under tibial component. Sacrificing the posterior cruciate ligament does not adversely affect durability of fixation of the total-condylar knee arthroplasty. Bone cement provides an excellent fixation of total knee implant.

Adult↗
PubMed1988

Pathologic studies of total joint replacement.

Articular endoprostheses are, in effect, foreign bodies designed to re-establish functioning articulations and are, therefore, capable of eliciting a local or systemic response to their presence. This article discusses the body's reactions to foreign bodies in general, and to endoprostheses in particular, and attempts to place those reactions into perspective regarding survival and failure of articular endoprostheses. The effects of size, shape, and composition of the materials used in the prosthetic components, and the mechanical factors acting on them to produce debris, are presented.

Bone and Bones↗
PubMedDate not supplied

Effect of posterior cruciate sacrificing on durability of the cement-bone interface: a nine-year survivorship study of 100 total condylar knee arthroplasties.

This paper presents a survivorship analysis of the second group of 100 consecutive primary total-condylar knee arthroplasties carried out in 75 patients between 1979-80 with a maximum follow-up of 9 years. With this type of knee arthroplasty the posterior cruciate ligament is routinely sacrificed. Survivorship results revealed that 98.9% of the knees had a good outcome at 9 years of follow-up, using revision surgery for aseptic and septic loosening, and radiographic evidence of global radiolucency or shift of the component as the end point. Radiographic survivorship analysis showed well-fixed components in 87% of implants using endpoint criteria of appearance and progression of radiolucency under the tibial component. Sacrificing the posterior cruciate ligament does not adversely affect the durability of fixation of total-condylar knee arthroplasty. Bone cement provides an excellent fixation of the total knee implant.

Adult↗