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Biomedical subjects

P F Lachiewicz

Publications and source records attributed to P F Lachiewicz.

68 records · Page 4Linked to original sources
PubMed1988

Fractures of the polyethylene bearing insert in Bateman bipolar hip prostheses.

Six cases of fractures of the polyethylene bearing insert of Bateman bipolar hip prostheses were observed in three patients at four to eight years after implantation. Three fractured prostheses were salvaged by replacement with new bearing inserts. In three patients, excessive acetabular cartilage wear was the indication for revision to total hip arthroplasty. Although dislocation and component disassembly have been reported as complications of the Bateman and other bipolar prostheses, fractures of the polyethylene bearing insert seems not to have been previously reported. The presumed mechanism of failure is cyclic loading of a femoral cup that is tipped into varus alignment. This concentrates stress on the weakest part of the polyethylene insert--the deep circumferential groove that joins the leaflets to the main body of the insert. Obesity and overuse were associated factors in this rare complication.

Adult↗
PubMed1987

Pathologic Malgaigne fracture following pelvic irradiation. A case report.

A 48-year-old woman developed symptomatic superior and inferior pubic rami fractures with a concomitant subluxation of the ipsilateral sacroiliac joint three years after pelvic irradiation for a gynecologic malignancy. Pathologic pelvic fractures (PPF) caused by irradiation may be difficult to distinguish from those caused by metastatic disease. PPF produce prolonged disability.

Brachytherapy↗
PubMed1986

Long-term results of Harris total hip replacement.

The long-term clinical and radiographic results of 38 Harris total hip replacements performed on 31 patients (average age, 50.7 years), with an average follow-up period of 11.5 years, were reviewed. According to a modified d'Aubigne-Postel hip rating system, 14 hips were rated excellent, 19 good, 4 fair, and 1 poor. Only one patient had revision surgery for symptomatic acetabular and femoral loosening. Eight acetabular components migrated, usually after 10 years; this did not correlate with an unsatisfactory clinical result, except in one hip. There was subsidence or loosening of the femoral component in five hips, usually associated with a technical error or severe calcar resorption; this occurred early and did correlate with an unsatisfactory clinical result. Clinical results were satisfactory in 86% of the hips with long-term follow-up study. However, radiographic failure occurred in 34% of the hips, with a predominance of late acetabular migration.

Adult↗
PubMed1986

Somatosensory-evoked potentials in the evaluation of the unstable rheumatoid cervical spine. A preliminary report.

Median nerve somatosensory-evoked potential (SEP) examinations were performed in 24 consecutive patients with rheumatoid arthritis who had symptomatic cervical spine instability. Eighteen patients had C1-C2 instability: in ten, the subluxation was completely reducible, and in eight, the subluxation was irreducible, with or without superior migration of the odontoid process. Four patients had superior migration alone, and two had subaxial subluxation alone. Abnormal SEPs were found in seven patients overall. However, 58% of those patients with irreducible atlanto-axial subluxation and/or superior migration of the dens demonstrated abnormal cervical cord conduction latencies. Patients with these radiographic findings may be at a higher risk for the development of overt myelopathy.

Adult↗
PubMed1986

Total hip arthroplasty in juvenile rheumatoid arthritis. Two to eleven-year results.

From 1971 to 1980, forty-five patients with juvenile rheumatoid arthritis had eighty-three cemented total hip replacements at The Hospital for Special Surgery and North Carolina Memorial Hospital. Thirty-four of these patients, with sixty-two involved hips, returned for examination and radiographs. The average age of these thirty-four patients at the time of surgery was twenty-six years, and twenty-seven of them, with forty-nine involved hips, were thirty years old or less. The average length of follow-up was six years (range, two to eleven years), with forty-one hips having been followed for five to eleven years. According to The Hospital for Special Surgery hip-rating system, thirty hips were rated excellent; nineteen, good; nine, fair; and four, poor. Of the four hips with a poor result, two (in the same patient) had severe heterotopic ossification with ankylosis postoperatively, and two had required revision: one for acetabular loosening six years after replacement and the other for a broken stem of the femoral component ten years postoperatively. Radiographic review of the sixty-two hips demonstrated progressive radiolucencies or migration of 26 per cent of the acetabular components and 8 per cent of the femoral components. The frequency of acetabular migration or progressive radiolucencies was related to the postoperative position of the component relative to the position of the true acetabulum. These results were somewhat better than those in other reports on cemented total hip replacement in young patients. The difference is probably related to the lower average weight and decreased activity level of patients with juvenile rheumatoid arthritis.

Activities of Daily Living↗
PubMed1985

Total knee arthroplasty in hemophilia.

Twenty-four total knee arthroplasties were performed in fourteen disabled patients with hemophilia. The average age of the patients at operation was thirty-five years. Twenty-one of the implants that were used were total condylar prostheses. Using The Hospital for Special Surgery knee-rating system after two to nine years of follow-up, the result in fifteen knees was rated as excellent; in six, as good; and in one, as fair. Two patients had a poor result that was attributable to late infection. Pain and function were markedly improved, and the average gain in range of motion was 23 degrees. Postoperative complications, in addition to the infections, included one subcutaneous hematoma, one hemolytic anemia, and one instance of inhibition to Factor VIII. The technical problems in treatment were formidable. Total knee arthroplasty in a hemophiliac can be successful, but it should be performed only with strict hematological supervision. The surgeon should be prepared to treat many potential postoperative complications.

Adult↗
PubMed1985

Treatment of supracondylar fractures following prosthetic arthroplasty of the knee.

Fifteen supracondylar fractures of the femur in patients with ipsilateral total knee arthroplasties were treated between 1975 and 1982. Three groups were identified for analyzation of treatment and end result. The average follow-up period after fracture was 18 months, with a range of ten to 48 months. Group I had four patients treated by closed reduction, cast immobilization, and early weight-bearing. At follow-up evaluation, three had a decrease in knee rating score, and one required a corrective osteotomy. Group II had eight patients treated by traction followed by cast or cast-brace immobilization. Four patients had a decrease in the knee rating because of malunion or loss of motion, and there was one nonunion requiring surgical treatment. Group III had three patients treated by immediate open reduction and internal fixation of the fracture. All three groups had functional arthroplasties following union of the fracture. Closed reduction and skeletal traction are recommended for the initial treatment. Open reduction and internal fixation, when technically feasible, is recommended when closed reduction and skeletal traction cannot maintain satisfactory alignment.

Aged↗
PubMed1984

Gaucher's disease.

This is a review of the classification, pathophysiology, and clinical manifestations of Gaucher's disease. The orthopedic manifestations of the disease include bone pain syndromes, pathologic fractures, and avascular necrosis of the femoral head in children and adults.

Adolescent↗
PubMed1984

Total ankle replacement in rheumatoid arthritis.

The indications for total ankle-replacement arthroplasty are controversial. Some preliminary experience with its use in patients with rheumatoid arthritis has been disappointing. However, in our fifteen single-axis arthroplasties, fourteen of the Mayo and one of the Buchholz type, after an average follow-up of thirty-nine months seven ankles were rated excellent and eight, good. The relief of pain was gratifying in all of the patients, only four patients having residual slight pain with starting activity. The average gain in the range of motion was 9 degrees. No patient had loosening that required reoperation, although radiolucent lines were seen in eleven ankles. Thirteen of the fifteen ankles had moderate to severe arthritic changes in the talonavicular, subtalar, or other intertarsal joints.

Adult↗
PubMed1981

Total hip replacement in Gaucher's disease.

We performed seven total hip replacements in six patients with the adult form of Gaucher's disease. Excessive perioperative hemorrhage was a common complication, and three patients have required revision of loosened components. Two of these were young patients with a more severe form of the disease. Total hip replacement is feasible and likely to be successful in the older patient with Gaucher's disease and osteonecrosis or failed prior hip surgery.

Adolescent↗