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Biomedical subjects

P F Lachiewicz

Publications and source records attributed to P F Lachiewicz.

At least 55 records · Page 3Linked to original sources
PubMed1994

Porous-coated total hip arthroplasty in rheumatoid arthritis.

Thirty-five porous-coated total hip arthroplasties were implanted in 25 patients with juvenile-onset or adult-onset rheumatoid arthritis and prospectively followed for a mean of 4.5 years (range, 3-6.5 years). Using the Harris hip rating, the mean hip score at the final follow-up evaluation was 91, and 86% of the hips had a good or excellent result. Thirty-one hips had no hip or thigh pain, while four had occasional slight pain. After surgery, 10 patients were employed and the remainder were ambulatory. There were no early or late deep infections. There was one reoperation for recurrent dislocation of the hip, but the components were not removed. Radiographic evaluation of the acetabular component showed that only one component had a complete radiolucent line in all three zones. Three femoral components had nonprogressive subsidence. At this intermediate-term follow-up period, porous-coated total hip arthroplasty is a promising technique that is likely to be successful in young patients with rheumatoid arthritis.

Adolescent↗
PubMed1994

Revision total hip arthroplasty with the BIAS (Biologic Ingrowth Anatomic System) femoral component. Three to six-year results.

The BIAS femoral component was used for most of the revision total hip arthroplasties performed during a four-year period by one surgeon. Forty-one BIAS femoral components were implanted in thirty-nine patients and were followed prospectively for a mean of five years (range, three to six years). The mean age of the patients was fifty-seven years. Twenty-eight (68 percent) of the femora were classified preoperatively as having severe loss of bone distal to the intertrochanteric line. Cancellous autogenous graft from the iliac crest or fresh-frozen cancellous allograft was used in all hips to fill the proximal defects. Weight-bearing was delayed for three months after the operation. Clinical and radiographic evaluation was performed with the use of accepted criteria. The mean preoperative Harris hip score was 36 points (range, 0 to 71 points) and improved postoperatively to 85 points (range, 53 to 100 points). Thirty-two (78 percent) of the hips had a good or excellent result at the most recent follow-up examination. Thirty-six patients (thirty-eight hips [93 percent]) had no or slight pain, and twenty-nine patients (thirty hips [73 percent]) walked with a slight or no limp. There was an association between one or more previous revisions of the femoral component and an increased prevalence of pain in the thigh or hip (p < 0.009). Radiographic analysis showed that thirteen components (32 percent) subsided, but eleven of them stabilized and subsidence was not associated with less satisfactory clinical results. The hip scores were not notably lower in this group. No component was revised, and no patient had clinical symptoms for which revision was indicated at the most recent examination. Revision total hip arthroplasty with use of this implant, which has a partial proximal porous coating and which is inserted without cement, provided similar clinical results but inferior fixation, as seen on radiographs, compared with reported revisions in which components were implanted with modern cementing techniques. However, the apparent reconstitution of femoral bone structure in areas of previous osteolysis or cortical thinning is encouraging. The senior one of us no longer routinely uses this specific implant for revision arthroplasty done without cement, but does use a similar, revised version of the prosthesis.

Aged↗
PubMed1994

Revision of the acetabulum without cement with use of the Harris-Galante porous-coated implant. Two to eight-year results.

Sixty revision total hip arthroplasties were performed in fifty-nine patients with use of the Harris-Galante-I porous-coated acetabular component. The patients were followed prospectively for a mean of five years (range, two to eight years). Multiple small screws were used for fixation of the component in all of the hips. Bulk allograft or cancellous bone graft was placed in forty-eight hips. The hips were evaluated clinically with use of the Harris hip-scoring system. A component was considered to be loose if there was a change in the cup angle of more than 5 degrees or vertical or horizontal migration of more than two millimeters, as demonstrated on serial radiographs. Forty-eight (80 per cent) of the sixty hips had a score of good or excellent at the time of the most recent follow-up. No component had radiographic evidence of loosening, and there were no broken screws or radio-lucent lines around the screws. Osteolysis of the pelvis was not seen in any patient. One hip was debrided because of a late metastatic deep infection, but the components were not removed. At the time of writing, no acetabular component had been revised and no revisions were pending. There were no complications related to the use of multiple small screws, even in the acetabula in which there was a severe deficiency of bone.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetabulum↗
PubMed1994

Total ankle arthroplasty. Indications, techniques, and results.

A high rate of complications and failure have limited the indications for total ankle replacement to older patients with rheumatoid arthritis, especially those with multiple joint involvement and limited physical activity. Recommended surgical technique for total ankle arthroplasty includes proper patient positioning, an anterior surgical approach, meticulous bone resection, and cemented fixation of components. Results of published studies suggest total ankle arthroplasty should not be performed in patients with posttraumatic arthritis who are younger than 60 years of age.

Aged↗
PubMed1993

Survivorship analysis of cemented high modulus total hip arthroplasty.

Ninety-four high-modulus total hip arthroplasties (THAs) were performed from 1977 to 1982 using the Computer Assist Design (CAD) and HD-2 prostheses. Eighty-six hips were followed for an average of 6.7 years. The cement gun was used throughout the study period, and distal bone or cement plug use was begun in 1979. The results of these arthroplasties were evaluated retrospectively using both survivorship analysis and observed success rates. Using a standard hip rating system, 19 hips were rated as excellent, 44 as good, 15 as fair, and 11 as poor. Failure was defined as definitely visible radiographic migration of either component, or reoperation for revision of one or both components. There was no significant difference between the HD-2 and CAD prostheses. There were five hips revised for aseptic loosening and revision was advised in an additional three hips. One hip with late sepsis required removal of both components. The five- and ten-year survivorships of the acetabular components were 97% +/- 3 and 58% +/- 17, respectively. Those of the femoral components were 93% +/- 5 and 78% +/- 13, respectively. For the components combined, the survivorship at five years was 91% +/- 6 but only 50% +/- 17 at ten years. Survivorship analysis provided a different and more realistic appraisal of the long-term results of the arthroplasties in this series than did the observed success rates. The contemporary cement techniques of the late 1970s and early 1980s may not be sufficient for the long-term survival of high-modulus THAs. Additional techniques may be necessary for improved long-term survival.

Acetabulum↗
PubMed1993

Hybrid total knee arthroplasty. Two- to five-year results using the Miller-Galante prosthesis.

Forty-one "hybrid" Miller-Galante total knee prostheses having porous-coated femoral and patellar components and a tibial component without a keel, cemented using low-viscosity technique, were implanted and prospectively evaluated for two to five years. The surgical technique was accurate, restoring the mechanical axis of the lower extremity to an average of 1.6 degrees varus. The average postoperative knee score was 90 points with 88% good or excellent results and 88% completely painless. Range of motion improved from a mean 88 degrees to a mean 108 degrees. Nonprogressive, incomplete radiolucent lines were present at the bone prosthesis interface in 27% of patellar, 15% of femoral, and 20% of tibial components. There were six patellar component fractures, four of which have been revised. These clinical and roentgenographic results support the "hybrid" technique for total knee arthroplasty. However, the use of the porous-coated, metal-backed patellar component is not recommended.

Adult↗
PubMed1992

A prospective study of 100 consecutive Harris-Galante porous total hip arthroplasties. 2-5-year results.

This is a prospective study of the authors' first 100 Harris-Galante porous total hip arthroplasties (THA) that were followed for 2-5 years. The mean age of the 83 patients was 43 years. Using the Harris hip rating system, 80% of the hips were rated as excellent, 13% as good, 5% as fair, and 2% as poor at final evaluation. Eighty percent of the hips had no pain, 11% had slight or occasional pain, 8% had activity-related pain, and 1% had moderate pain. Eighty-seven percent of the hips had no limp, 8% had a slight limp, and 5% had a moderate limp. One femoral component, placed as a conversion of a loose bipolar hemiarthroplasty, has been removed for loosening. Two other hips have been reoperated, one for lengthening the femoral neck and one for changing the acetabular liner. There were no problems with acetabular screw fixation and no component migrated. Only two hips had 1 mm nonprogressive radiolucent lines in all three zones. Femoral component subsidence of 3 or more mm was measured in 16 hips, but was progressive in only 1. Radiolucent and radiodense lines were frequently seen in the nonporous coated regions of the femoral stem. Loss of proximal medial femoral bone density was seen in 59% of hips, and calcar resorption was seen in 16% of hips. Although the clinical results of this uncemented implant system were good or excellent in 93% of hips, the high incidence of femoral component subsidence is worrisome.

Adolescent↗
PubMed1991

Rhabdomyolysis following total hip arthroplasty.

We report six cases of contralateral limb involvement during total hip arthroplasty including swelling of the gluteal muscle compartments, rhabdomyolysis, myoglobinuria, and sciatic nerve palsy. The risk factors for such complications include obesity, prolonged operative time, and positioning in the lateral decubitus position. The laboratory and clinical findings are consistent with a gluteal muscle crush-injury with consequent compartment syndrome. The patients should be treated conservatively as symptoms can be expected to resolve.

Adult↗
PubMed1991

Internal fixation of femoral neck fractures. A comparative biomechanical study of Knowles pins and 6.5-mm cancellous screws.

In a comparative biomechanical study of the stability of experimentally produced femoral neck fractures fixed with Knowles pins or with 6.5-mm cancellous screws, 12 matched pairs of anatomic specimen femurs were divided into four groups of standardized osteotomies. One member of each matched pair was fixed with three or four 6.5-mm cancellous screws, whereas the other member was fixed with the same number of Knowles pins. Mechanical testing was performed on an Instron testing machine. There was no statistically significant difference in maximum load to failure or in fixed stiffness between the two methods of fixation. When examining maximum load to failure, three of either device provided fixation equivalent to four. Although there was a difference in absolute fixed stiffness between specimens fixed with three Knowles pins compared to four, when stiffness was expressed as a percentage of intact stiffness, there was no difference between any fixation group. From an analysis of the observed modes of failure and from calculations of the flexural rigidity provided by the devices, it is proposed that the quality of the trabecular bone of the femoral neck is a major factor in the experimental fixation of femoral neck fractures.

Biomechanical Phenomena↗
PubMed1991

A new technique for removal of the total hip arthroplasty acetabular component.

In revision total hip arthroplasty, an arthrographically loose or migrated cemented or porous ingrowth acetabular component may be found to be quite secure and difficult to remove. An acetabular component that is not loose may need to be removed because of infection or malposition. Based on a previous study of torque failure of cemented and uncemented acetabular components in vitro, a pneumatic impact wrench has been developed that delivers repetitive shear loads to the implant-cement or implant-bone interfaces. Eight acetabular components (three polyethylene, two metal backed, and three porous coated) were implanted with polymethylmethacrylate into fresh, unembalmed human anatomic specimen acetabuli. Seven components were easily removed using this new device at an average setting of 16 kg/m of torque. One polyethylene component could not be removed because the studs cut through polyethylene grooves. In one pelvis, a fracture occurred through a pubic anchoring hole when the driver was taken by error through a 40 degrees arc rather than the recommended 15 degrees arc. This device has been used in vivo in four cases, easily removing the components without damage to the surrounding bone.

Acetabulum↗
PubMed1990

Aspirin prophylaxis and surveillance of pulmonary embolism and deep vein thrombosis in total hip arthroplasty.

This is a prospective study of aspirin prophylaxis and thromboembolism surveillance in 159 patients having total hip arthroplasty by one surgeon at one institution. All patients had preoperative venous Doppler examination of the lower extremities and a ventilation-perfusion lung scan. Aspirin (650 mg) was given the night prior to surgery and continued at that dose twice per day. Venous Doppler examination was performed 10-14 days after operation. Asymptomatic pulmonary embolism was treated with oral anticoagulation only. There was a 12.6% incidence of pulmonary embolism, but only 1.9% of all patients developed a symptomatic pulmonary embolus. No patient had a fatal pulmonary embolus. No patient had a clinically evident deep vein thrombosis, and venous Doppler examination detected only nine patients with deep vein thrombosis (5.7%). The venous Doppler examination could not predict which patients would develop a pulmonary embolism. The authors could not determine a group of patients at high risk for the development of pulmonary embolism. There was no correlation between well-established "risk factors" and the development of pulmonary embolism. There was no correlation between the use of cemented or uncemented components and the development of pulmonary embolism. There were few complications of this prophylactic regimen of aspirin and surveillance. The authors believe this may be an acceptable prophylactic regimen for patients having total hip arthroplasty. However, the value of venous Doppler examination in the detection of deep vein thrombosis following total hip arthroplasty is uncertain.

Aspirin↗
PubMed1990

The effect of radiation therapy on the fixation strength of an experimental porous-coated implant in dogs.

Radiation therapy prevents heterotopic ossification after cemented total hip arthroplasty, but its effect on the fixation of porous-coated devices is not known. The purpose of this study was to determine the effect of irradiation on the pullout strength of a porous implant in the canine model. A custom-designed titanium fiber metal-coated cylinder was implanted into the distal femurs of 12 dogs. One femur of each dog was irradiated with 10 Gy, given in four 2.5-Gy daily fractions beginning one day after surgery. Serial bone scans were performed at one, two, four, and six weeks postoperatively. At six weeks, the femurs were harvested, and eight were randomly selected for mechanical testing. Scintigraphic evaluation showed a significant reduction in uptake at one and two weeks in the irradiated limb, but this had returned to normal at four and six weeks. The failure to pullout was significantly less in the irradiated limb compared with the control limb six weeks postoperatively. In this canine model, the pullout strength of the titanium fiber implant was significantly reduced by a dose of radiation commonly used in the prevention of heterotopic ossification. If irradiation is chosen for prophylaxis, either the porous implant should be adequately shielded or a cemented implant should be utilized.

Animals↗
PubMed1990

Factors influencing the results of open reduction and internal fixation of tibial plateau fractures.

Forty-three displaced tibial plateau fractures were treated with open reduction and internal fixation. The fractures were classified into four groups, and the clinical results were evaluated using a standard 100-point knee rating system. The average follow-up period after surgery was 2.7 years. Overall there were 35 excellent, five good, three fair, and no poor results. In five of eight knees with a less than excellent score, the results were due to the technique of fracture fixation or the absence of a bone graft. There were ten postoperative complications, but only one ultimately affected the clinical result. Fourteen patients required removal of implants. Roentgenographic analysis showed that six knees had mild degenerative changes, two had moderate, and two had severe degenerative changes. There was no statistically significant association between the fracture type and a less than excellent result. The absence of bone grafting, however, was associated with a less than excellent result. Bicondylar fractures had a mean range of motion of 110 degrees, 18 degrees less than that of all other types of fracture combined.

Adolescent↗
PubMed1989

In vitro initial fixation of porous-coated acetabular total hip components. A biomechanical comparative study.

Two-phase in vitro testing was performed to determine the initial mechanical stability of uncemented but fixed porous coated acetabular components. Six each of three-screw fixation, two-peg fixation, and three-spike fixation porous acetabular components were implanted into fresh and embalmed human cadaver acetabula. Measurement of prosthesis-bone displacement at a load of 100 kg did not show a significant difference among the three methods of fixation. However, torque testing showed that three-screw fixation failed at significantly higher loads (46 N-m) than two-peg fixation (32 N-m) or three-spike fixation (32 N-m).

Acetabulum↗
PubMed1988

The bipolar endoprosthesis in avascular necrosis of the femoral head.

The authors reviewed the clinical and radiographic results of 31 bipolar hip arthroplasties performed for avascular necrosis in 24 patients. The average patient age at the time of operation was 43 years, and the average follow-up period was 4.6 years. Using a modified Hospital for Special Surgery hip rating system, the results were excellent in eight hips, good in seven, fair in eight, and poor in eight. Eight hips had residual pain despite a satisfactory rating. Four hips have required revision. There was a correlation between the patient's age and preoperative radiographic stage and the clinical result. Abduction-adduction weight-bearing radiographs showed that only 33% of the hips had significant inner-bearing motion. Superior acetabular cartilage narrowing or migration of the acetabular component was seen in 14 hips. Femoral component subsidence occurred in seven hips.

Adult↗