Biomedical subjects

L E Zatorski

Publications and source records attributed to L E Zatorski.

11 recordsLinked to original sources

PubMed1999

Total hip replacements done without cement after acetabular fractures: a 4- to 8-year follow-up study.

Twenty-one patients (21 hips) underwent cementless total hip replacement surgeries for previous acetabular fractures. The mean age at the time of hip replacement was 52 years (range, 23-78 years). The mean follow-up was 65 months (range, 48-104 months). One hip required revision of the stem secondary to a periprosthetic femur fracture from a fall at 3 months after surgery. Good to excellent clinical rating was achieved and maintained in 19 hips. Radiographic evaluation demonstrated stable cup and stem fixation in 17 and 15 hips. Only 1 patient with radiographic loosening of the components was sufficiently symptomatic. The results in this series appeared slightly better than those reported previously in hip replacements done with cement at comparable medium-term follow-up. The mechanical failure rates remained high in this patient population: 19% for the cups and 29% for the stems.

Acetabulum↗

PubMed1998

Total hip arthroplasty performed without cement in patients with femoral head osteonecrosis who are less than 50 years old.

Seventy-two cementless total hip arthroplasties were performed by a single surgeon in 58 patients with the diagnosis of femoral head osteonecrosis. All patients were less than 50 years old (mean, 37 years). The mean follow-up was 84 months with a minimum of 48 months. Good-to-excellent results were maintained at final follow-up in 94% of the hips. Revision rate was 1.5% each for the cups and the stems. Mechanical failure rate was 7.6% for the cups, and 6% for the stems. If the results were analyzed excluding the data from the group of patients who received the Mittelmeier prostheses, the mechanical failure rates for the cups was 0% and for the stems was 4.2%. The probability of survival for the entire series using revision as the endpoint was 96.9% at 11 years. Survival probability decreased to 88.5% if radiographic failures were included. Excluding the Mittelmeier prostheses, survival probability was estimated to be 100% for the cups using both revision and radiographic failures as endpoints; for the stems, the survival probability was 98.0% using revision as the endpoint and 95.8% including radiographic failures. Femoral osteolysis was observed in 1.5% of the hips. No hip had acetabular osteolysis. No measurements of polyethylene wear were attempted in this study. These results appeared superior to total hip arthroplasties done with early cementing techniques in this population of young patients with femoral head osteonecrosis.

Adult↗

PubMed1998

A comparison of the cost effectiveness of one-stage versus two-stage bilateral total hip replacement.

Forty patients underwent 80 bilateral primary total hip replacements (THRs) under the same anesthesia (one-stage). Forty other patients who underwent unilateral primary THRs during the same time interval were selected to match the first 40 patients with regard to age, sex, diagnosis, weight, medical comorbidity, type of prosthesis used, and perioperative management protocol. An assumption was made in that each unilateral case represented the first side of bilateral THRs performed during two separate hospitalizations (two-stage). Analysis of the total hospital charges submitted to the insurance companies was made between the groups. On average, there was a 24% reduction (P<.05) for each case if bilateral THRs were done in one stage. This was primarily due to a significant decrease (P<.05) in the length of hospital stay in the one-stage group. There was no difference between the two groups in the operative time, estimated blood loss, or perioperative complications.

Aged↗

PubMed1997

Unsatisfactory results of a first-generation modular femoral stem implanted without cement. A 4- to 9-year follow-up study.

Eighty primary total hip arthroplasties were performed using a first-generation modular femoral stem inserted without cement. Modular distal sleeves made of methacrylate were used in 33% of the hips. Dorr type B or C femoral geometry was present in 80% of the cases. The mean follow-up period was 81 months with a minimum of 48 months. Satisfactory clinical results were observed in 74% of the hips at the final follow-up visit. Revision of the stem had been performed in 14% of the hips, all for aseptic loosening. The overall mechanical failure rate was 48%. Canal fill by the stem was not any better with the sleeves than without. The incidence of failure, however, was less in those hips in which sleeves were used. Femoral osteolysis was present in 19% of the hips. The experience with this particular stem design has been disappointing.

Adult↗

PubMed1996

Cementless total hip arthroplasties using ceramic-on-ceramic articulation in young patients. A minimum 5-year follow-up study.

Cementless total hip arthroplasties were performed in 25 consecutive young patients (27 hips), with a mean age of 36.5 years, using prostheses that offered ceramic-on-ceramic articulation. The median follow-up period was 75 months, with all hips being followed a minimum of 5 years. Revision surgery was necessary in one hip at 60 months for fracture of the cup. Ninety-six percent of the remaining hips were rated good or excellent clinically using the Harris hip scale. Radiographic loosening of one or both components was evident in 3 hips. There was no incidence of femoral or acetabular osteolysis observed at follow-up periods of 5 to 8 years.

Adolescent↗

PubMed1996

Total hip replacements using the ceramic Mittelmeier prosthesis.

One hundred twelve consecutive primary total hip replacements were performed for osteoarthritis or osteonecrosis by a single surgeon using the Mittelmeier ceramic prosthesis without cement between January 1983 and July 1984. Ninety-three of these hips were followed prospectively to a minimum of 60 months and a median of 108 months. Five (5.4%) hips have been revised for loosening. Of the remaining hips, 77 (87.5%) were rated clinically satisfactory. Cumulative survival probability using revision as endpoint was estimated to be 92.7% at 5 years and 87.9% at 10 years. However, overall mechanical failure rates were 21.5% for the cup and 22.6% for the stem. There was no case of either femoral or acetabular osteolysis observed.

Adolescent↗

PubMed1995

Total hip arthroplasty using the Zweymuller stem implanted without cement. A prospective study of consecutive patients with minimum 3-year follow-up period.

A prospective study was undertaken over a 2-year period to evaluate the clinical efficacy of using the Zweymuller femoral component (Allopro, Berne, Switzerland) in cementless total hip arthroplasty. Forty consecutive patients (46 hips) were included for final evaluation. Ninety-four percent of the femurs were classified as Dorr class B or C before surgery. The mean follow-up period was 50 months (median, 48 months). Ninety-eight percent of the hips were rated good or excellent clinically. No stem was classified as definitely loose. No hip has required any reoperation. There was no incidence of femoral or acetabular osteolysis up to 6 years.

Adult↗

PubMed1995

Oblique femoral osteotomy in cementless total hip arthroplasty. Prospective consecutive series with a 3-year minimum follow-up period.

Success of total hip arthroplasty using cementless implants is dependent on intimate contact of the prostheses with viable host-bone and achievement of optimal fit and rigid implant fixation. A technique of oblique femoral osteotomy has been used to correct proximal femoral deformity and to facilitate difficult revision surgery in selected cases. This prospective study included 26 osteotomies performed in 25 consecutive patients with a minimum follow-up period of 3 years. The median follow-up period was 50 months. Eighty-four percent of the reconstructions remained in situ at the final follow-up examination, with 81% of them rated clinically excellent or good. Three stems were revised for aseptic loosening at a mean interval of 46 months. One additional femoral revision was necessary for nonunion of the osteotomy. Two of the remaining stems were classified as radiographically loose. Although oblique femoral osteotomy serves as a useful adjunct surgical technique in difficult femoral reconstructions, nearly 25% of the hips in this study either failed or were loose at the medium-term follow-up examination. Long-term success of this technique with cementless prostheses remains to be defined.

Adult↗

PubMed1995

[Anterior approach in hip prosthesis].

The anterior approach for total hip endoprosthetics (THE) developed by K. J. Keggy was used in about 3,000 patients. It is characterized by rapid accomplishment, the possibility of anatomical inspection of the joint and correct orientation of the acetabular component of the endoprosthesis. Difficulties are not encountered in exposure of the femur and favorable conditions are provided for separation of the soft tissues. Considering our preference for noncemented THE, we have been using in the recent years a modified approach. The average duration of the operation, except for revision THE, did not exceed 90 minutes. The approach is atraumatic for the para-articular soft tissues, which provides the possibility of early postoperative mobilization and rehabilitation and reduced the duration of postoperative in-patient treatment to 7.3 days. The incidence of complications was not higher, and in many respects was even lower, than that reported in the literature dealing with primary and revision THE. At present we still use the anterior approach in all operations for THE although essential contradictions occur in discussion of the advantages of cemented implants over noncemented prostheses. The suggested method for THE is best for most patients.

Adolescent↗

PubMed1991

Primary ceramic hip replacement: a prospective study of 119 hips.

A prospective study of 119 consecutive primary ceramic total hip arthroplasties (Autophor, Smith & Nephew) was performed. Follow up was 100% at a minimum of 3 years. Six hips were revised during the course of the study (5%). Harris hip scores were 29.0 preoperatively, 78.7 at 6 weeks, and 92.6 at 3.4 years (range: 62 to 100). Ninety-one percent of the 107 surviving hips at follow up had a good or excellent hip score. The clinical results matched those of Mittelmeier. Thigh pain was a frequent finding, but rarely presented a clinical problem. Our incidence of thigh pain may be higher than that of others because no patients were lost to follow up. The ceramic portion of the Autophor Ceramic Hip was well tolerated clinically and radiographically. The femoral component was responsible for 2% to 4% of the revisions, and we have now replaced it with a stem designed for bony stabilization.

Adolescent↗

PubMedDate not supplied

Anterior approach to total hip replacement: surgical technique and clinical results of our first one thousand cases using non-cemented prostheses.

Total hip replacement has evolved into one of the most frequently performed reconstructive procedures in orthopaedic surgery today. A modified anterior approach developed by the senior surgeon has been utilized in performing over 3,000 operations in the past two decades. It is a unique and facile exposure. It can be easily applied to primary and revision surgery. Noncemented prostheses have been used in over 1,000 of these operations. This article details the surgical exposure, acetabular and femoral preparation for both non-cemented and cemented prostheses, special considerations for revision surgery, and the clinical results of the experience with noncemented prostheses to date.

Bone Cements↗