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Paul F Lachiewicz

Publications and source records attributed to Paul F Lachiewicz.

At least 19 recordsLinked to original sources
PubMed2007

Case report: a thigh mass resulting from polyethylene wear of a revision total hip arthroplasty.

The case of a 60-year-old man who had an enlarging thigh mass seen during a routine 12-year examination of a cementless revision total hip arthroplasty is presented. Aspiration of the mass yielded more than 200 cc of thick yellow fluid. Cytopathologic examination disclosed material consistent with polyethylene wear debris. The porous titanium acetabular and femoral components were not loose. Reoperation was recommended despite minimal symptoms, because the fluid-filled mass recurred after aspiration. At the time of reoperation, the components appeared well fixed and a linerhead exchange was performed. One year after surgery, the mass had not recurred and the patient had minimal symptoms.

Arthroplasty, Replacement, Hip↗
PubMed2006

Polyethylene liner exchange of the Harris-Galante porous I and II acetabular components without cement: results and complications.

This study reviewed the long-term efficacy of the locking mechanism of the Harris-Galante porous (HGP) I and II acetabular components and the results and complications of polyethylene liner exchange without cement. There were 400 HGP-I components with a mean follow-up of 10 years (range, 2-19 years) and 78 HGP-II components with 8 years of mean follow-up (range, 2-13 years). There has been only 1 liner dislodgement (0.2%). Thirty-five hips (34 patients) have undergone liner exchange without cement. The index acetabular component was implanted as a primary procedure in 19 hips and a revision in 16 hips. No exchanged liner has dislodged at a mean follow-up time of 5.1 years (range, 2-11 years). However, there have been 7 patients (20%) with recurrent dislocation and all required reoperation. Dislocation was significantly lower when an elevated rim liner was used.

Acetabulum↗
PubMed2006

Ten-year survival and clinical results of constrained components in primary total knee arthroplasty.

The use of constrained prostheses in primary total knee arthroplasty (TKA) is unusual. This is a study of the indications, clinical results, and 10-year survival of these components. Fifty-four knees (44 patients) were prospectively followed, and 42 knees (34 patients) had 5 to 16 years (mean, 9 years) of follow-up. The indications for the components were valgus deformity with incompetent medial collateral ligament in 27 knees, severe flexion contracture with inability to balance the knee in 12, and others in 3. Knees were evaluated by the Hospital for Special Surgery and Knee Society score systems. Statistical analysis included paired Student t test and survivorship analysis. Of the entire cohort of 54 knees, there were only 2 failures: a tibial loosening revised at 3 years and a femoral loosening (no stem) revised at 1 year. Of the 42 knees with minimum 5-year follow-up, 12 knees were rated as excellent, 24 good, 3 as fair, and 3 as poor. There was a significant improvement in postoperative knee score, but not in the function score. The mean flexion contracture preoperatively was 17 degrees; postoperatively, 1.7 degrees; and mean flexion preoperatively, 93 degrees; postoperatively, 97 degrees. The 10-year survival with failure, defined as component revision for loosening, was 96% (confidence interval, 90.6%-100%). In difficult primary TKAs, there were 86% good or excellent results and a 10-year survival of 96% despite the increased constraint. The constrained condylar TKA remains indicated for knees with severe valgus deformity, incompetent medial collateral ligament, or severe flexion contracture in which the knee cannot be properly balanced.

Adult↗
PubMed2006

Patella maltracking in posterior-stabilized total knee arthroplasty.

Maltracking of the patella component in total knee arthroplasty usually leads to complications such as subluxation, dislocation, fracture, excessive wear, or implant failure. After using a new posterior-stabilized total knee arthroplasty and a specific protocol for the patellofemoral articulation we determined the incidence of lateral retinacular release and patella complications. We retrospectively reviewed 255 consecutive primary posterior-stabilized total knee arthroplasties with an anatomic femoral component and a three-peg offset-dome patella. Component alignment was achieved using Whiteside's lines for the femoral component, the medial border of the tubercle for the tibial component, and previously reported techniques for the patella. Lateral release was performed in 15 knees (6.2%), most of which had excessive preoperative valgus (mean, 15 degrees). There were no reoperations for the patellofemoral joint at a mean followup of 3.7 years (range, 2-7 years). Two patients had asymptomatic osteonecrosis of the patella with complete radiolucent lines, and one patella fracture was treated with immobilization. We believe patella maltracking a largely avoidable problem in total knee arthroplasty. We found a low incidence of lateral retinacular release and patella complications using these components and this protocol for the patellofemoral articulation.

Aged↗
PubMed2006

Dislocation of primary total hip arthroplasty with 36 and 40-mm femoral heads.

Some authors suggest the use of larger (36 and 40 mm) femoral heads against highly cross-linked polyethylene acetabular liners will reduce the prevalence of early dislocation after primary total hip arthroplasty (THA). We prospectively followed 61 consecutive patients at high risk for dislocation to determine the prevalence of early dislocation after primary THA with 36 and 40 mm femoral heads. We established specific indications for the use of these larger heads in primary arthroplasty. There were 65 hips in 61 patients with a minimum followup of 1 year (mean 2 years, range 1-4 years). There were 55 36 mm heads and 10 40 mm heads. All arthroplasties were performed by the posterior approach with capsular repair. The prevalence of early dislocation was 4.6% (3 of 65). There was one patient with an anterior dislocation and two with posterior dislocation. No patient underwent reoperation for dislocation. There was no dislocation in the 10 hips that had a 40 mm head. We identified no complications related to the larger femoral heads. The use of larger femoral heads did not notably reduce the prevalence of early dislocation after primary THA in high risk patients compared to historical controls.

Aged↗
PubMed2006

Multimodal prophylaxis for THA with mechanical compression.

We used mechanical thromboembolism prophylaxis using intraoperative thigh-calf pneumatic compression and other measures in 1032 consecutive primary and revision total hip arthroplasties. No chemical prophylactic measures were used until after duplex ultrasonography was performed by experienced technologists before discharge. Asymptomatic proximal thrombi were treated with low molecular weight heparin and warfarin, whereas those patients with a negative scan or distal thrombi only were advised to take aspirin 325 mg twice a day for 6 weeks. Regional anesthesia was used in 95% of the arthroplasties. Using this protocol, the 30-day mortality was 0.3%. There was one autopsy-proven fatal pulmonary embolism (0.09%). One other patient died suddenly with cardiac arrest after abdominal pain and vomiting, but no autopsy was performed. Symptomatic pulmonary embolism occurred in seven patients (0.7%), four occurring early and three late. Only one of these seven patients had a positive duplex scan. Deep vein thrombosis occurred in 41 patients (3.9%) and 35 remained asymptomatic. We observed no association between type of surgery (primary or revision), age, gender or preoperative diagnosis and pulmonary embolism or deep vein thrombosis. The data confirm the efficacy of a multimodal protocol with thigh-calf mechanical prophylaxis for almost all patients undergoing primary or revision total hip arthroplasty.

Adult↗
PubMed2005

Fracture of the femur in revision hip arthroplasty with a fully porous-coated component.

Fifty-four consecutive femoral component revisions with uncemented fully porous-coated stems were retrospectively reviewed for the prevalence of intraoperative fracture. Fracture of the femoral diaphysis occurred during insertion of a curved stem in 8 (15%) hips. One additional distal fracture of the femur occurred during exposure of the hip. All fractures occurred with a curved femoral stem. Treatment for intraoperative fractures included open reduction and internal fixation with cortical strut grafts and cables followed by protected weight bearing. This was successful in 6 hips. Even with the use of a curved stem, we report a high prevalence of intraoperative fracture of the femur in revision hip arthroplasty.

Adult↗
PubMed2005

Precoated femoral component with proximal and distal centralizers: results at 5 to 12 years.

One study, confounded by the use of crystalline polyethylene and ceramic heads, reported a high rate of early failure of a precoated femoral component with proximal and distal centralizers. The present study reports the prospective clinical and radiographic results, and 10-year survival data of 166 consecutive hybrid total hip arthroplasties using this femoral component. An A or B cement grade was obtained in 93% of hips. At a mean follow-up time of 7 years (range, 5-12 years), there were only 4 (2.4%) femoral failures. Ten-year survival of this component was 95% (confidence interval, 94%-99%). The rate of radiographic failure and revision of this component implanted with conventional polyethylene and cobalt chrome heads is similar to that reported with other "modern" femoral components.

Aged↗
PubMed2005

Changing indications for revision total hip arthroplasty.

This was a retrospective review of two cohorts of 100 consecutive revisions performed 10 years apart by one surgeon, to determine the major reason for reoperation. For the early cohort, the indications for revision were: loosening of both components (38%), loosening of acetabular component (22%), loose hemiarthroplasty (13%), infection (10%), loosening of femoral component (8%), periprosthetic fracture (6%), recurrent dislocation (2%), and wear (1%). For the recent cohort, the indications for revision have significantly changed: loosening of acetabular component (24%), loosening of femoral component (22%) (p = .0048), recurrent dislocation (16%) (p = .0011), loosening of both components (15%) (p = .0002), wear-osteolysis (7%) (p = .03), infection (7%), loose hemiarthroplasty (6%), and periprosthetic fracture (3%). There has been a change in the indications for revision hip arthroplasty compared with 10 years ago, with a statistically significant increase in revisions for dislocation, wear-osteolysis, and loosening of the femoral component only.

Adult↗
PubMed2004

Modular revision for recurrent dislocation of primary or revision total hip arthroplasty.

Two surgeons who used the same implants and surgical approach performed 23 revisions for recurrent dislocation of modular total hip arthroplasty (THA) with retention of components. For 17 primary hips, there was a mean of 3.8 (range, 2-10) dislocations before revision. Fifteen hips had exchange of the acetabular liner, 13 had a change in neck length, and 5 had a change in size of the femoral head. At a mean follow-up of 4 years (range, 2-7 years), 14 patients (82%) had no further dislocation, 1 had 1 additional dislocation, and 2 required additional surgery. For the 6 revision procedures, the mean number of dislocations was 3.8 (range, 2-10) before re-revision. Liner exchange was performed in 4 hips, neck length changed in 3 hips, and head size increased in 2 hips. At a mean follow-up of 3 years (range, 2-5 years), only 3 patients (50%) had no further dislocation, and 2 required additional surgery. Modular revision can be a successful method of treatment of recurrent dislocation after primary THA, but is much less successful after revision THA.

Adult↗
PubMed2004

Factors influencing the longer-term survival of uncemented acetabular components used in total hip revisions.

BACKGROUND: There are few longer-term follow-up reports of the results and complications of the use of cementless acetabular components in revision hip arthroplasty. In this study, we analyzed the clinical and radiographic results to determine the factors that affect longer-term survival of titanium-fiber-metal-coated acetabular components. METHODS: During a fourteen-year period, one surgeon performed 211 consecutive unselected cementless acetabular revisions in 194 patients with a mean age of sixty-two years. The same technique was used for all revisions: the component was impacted and was fixed with multiple screws, and bone deficiencies were augmented with supplemental bone graft. Both the acetabular and the femoral components were revised in 142 hips, whereas an isolated acetabular revision was performed in sixty-nine hips. All 211 revisions were included in a survivorship analysis to twelve years. Prospectively determined clinical results in 135 hips and radiographic results in 131 hips were available at a minimum of five years postoperatively. RESULTS: Seven acetabular components were removed: three, because of infection; one, because of recurrent dislocation; and three, because of mechanical loosening. There was asymptomatic radiographic loosening of one additional acetabular component, for a total rate of aseptic loosening of 2%. The twelve-year prosthetic survival rate was 95% (95% confidence interval, 91% to 99%), with failure defined as component removal for any reason. There was no significant difference in the rate of survival of the cup or femoral component between the sixty-nine hips treated with isolated acetabular revision and the 142 hips in which both components were revised. There was a significant difference in the rate of dislocation between the hips treated with isolated acetabular revision (dislocation in fourteen hips, 20%) and those in which both components had been revised (dislocation in eleven hips, 8%; p = 0.03), but there was no difference in component survival if a dislocation occurred. There was a significant association between a patient weight of >82 kg and acetabular failure (p = 0.04). CONCLUSIONS: This titanium-fiber-metal-coated hemispheric component fixed with multiple screws had a twelve-year survival rate of 95% when used in an unselected, consecutive series of acetabular revisions. The rate of dislocation was significantly higher in the patients treated with isolated acetabular revision, and routine postoperative bracing is now recommended for that group.

Acetabulum↗
PubMed2004

The rates of osteolysis and loosening associated with a modular posterior stabilized knee replacement. Results at five to fourteen years.

BACKGROUND: Osteolysis and increased polyethylene wear have been reported in association with several designs of modular total knee prostheses. The purpose of the present study was to evaluate a modular posterior stabilized prosthesis to determine its clinical performance as well as the rates of component loosening and osteolysis. METHODS: We performed a prospective, consecutive study of 193 knees in 131 patients who were managed with the modular Insall-Burstein II posterior stabilized total knee prosthesis by one surgeon. The mean age of the patients at the time of surgery was sixty-eight years, and the mean duration of follow-up was seven years (range, five to fourteen years). Clinical evaluation was performed with use of standard knee-scoring systems. Radiographs were evaluated for the presence of radiolucent lines, osteolysis, and loosening. RESULTS: The overall result (as determined with the Hospital for Special Surgery scoring system) was rated as excellent for 112 knees, good for sixty, fair for fifteen, and poor for six. The mean postoperative flexion was 112 degrees. No clinical or radiographic loosening of the tibial component was noted. Eight knees had osteolytic lesions of the tibia. Thin, incomplete, nonprogressive radiolucent lines were noted around thirty tibial components (16%). There were three reoperations. CONCLUSIONS: Despite previous reports of osteolysis, polyethylene wear, and loosening in association with some modular total knee implant designs, there was no loosening in this series of posterior stabilized total knee replacements and only eight knees had tibial osteolysis after a mean duration of follow-up of seven years. We believe that total knee arthroplasties that are performed with use of cemented modular posterior stabilized components can have a high rate of intermediate-term success. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.

Activities of Daily Living↗
PubMed2004

Hip arthroplasty after extracapsular hip fracture: a matched pair cohort analysis.

Eighteen patients with a prior intertrochanteric or basicervical hip fracture had a total or bipolar hip arthroplasty. The clinical and radiographic results of these patients were compared to a control group of patients (matched for age, gender, associated diagnoses, and length of follow-up) who had a primary total hip arthroplasty. There was a significant increase in intraoperative blood loss, operative time, and number of units of blood transfused in the fracture group compared to the primary arthroplasty group. The mean preoperative Harris hip scores were not significantly different between the two groups, but the postoperative scores were significantly lower for the fracture group (p < .001). There was no notable difference in the rates of radiographic loosening or heterotopic ossification between the two groups. The results of this study suggest that patients should be counseled preoperatively that the functional outcome of hip arthroplasty after internal fixation of extracapsular hip fractures is decreased compared to control patients with a primary total hip arthroplasty.

Adult↗
PubMed2004

Implant design and techniques for patellar resurfacing in total knee arthroplasty.

There are two basic techniques for resurfacing of the patella in total knee arthroplasty. The inset patellar component recesses a circular dome with a single fixation peg into a reamed patella while the onlay component is placed onto the cut surface of patella. Onlay patellar components have a wide variety of shapes, designs, and methods of fixation. There are differences in technique and possible complications with the inset and onlay patellar components. However, neither method has proved to be superior. Fixation of an onlay patellar component is usually with cement, but successful cementless porous-coated designs exist. Fixation of an all-polyethylene patellar component occurs by cementing a component with either a single central peg or three smaller peripheral pegs; although one method is not preferred over the other, there have been reports of breakage with three pegs. The design and fabrication of these components are important to prevent peg breakage with repeated shear stress. There are few clinical data implicating the different shapes or methods of patella component fixation with the complications of anterior knee pain, wear, patella fracture, and component breakage. Attention to detail during surgery is likely the most critical factor to the success of patellar resurfacing in total knee arthroplasty.

Arthroplasty, Replacement, Knee↗
PubMed2003

Precoated femoral component in primary hybrid total hip arthroplasty: results at a mean 10-year follow-up.

This is a mid-term report at 10 years' mean follow-up of a study of a precoated femoral component used in primary hybrid total hip arthroplasty (THA). Of an original cohort of 98 hips undergoing THA performed by one surgeon, 75 hips in 65 patients (mean age, 67 years) were prospectively followed up for 7 to 12 years (mean, 10 years). All hips had the same porous coated acetabular component and a precoated femoral component (with an oval cross-section) implanted using Simplex bone cement (Howmedica, Rutherford, NJ). There was no femoral component loosening or revision. Two acetabular components in patients with rheumatoid arthritis and protrusio acetabulae had radiographic loosening; however, only 1 was symptomatic and was revised. Acetabular osteolysis was seen in 4 hips (5.3%), and minor femoral osteolysis was seen in 3 hips (4%). Used in this manner in this patient population, precoating is not detrimental to successful fixation at 10 years' mean follow-up of primary hybrid THA.

Acetabulum↗