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Biomedical subjects

R B Gustilo

Publications and source records attributed to R B Gustilo.

At least 37 records · Page 2Linked to original sources
PubMed1995

Extramedullary versus intramedullary alignment guides in total knee arthroplasty.

Use of extramedullary and intramedullary guides to prepare the tibia was studied comparatively in 100 consecutive primary total knee arthroplasties done by a single surgeon. Each type of guide was used in 50 consecutive cases, for a total of 100 cases. In all cases, an intramedullary guide was used to prepare the distal femur. Long (hip to ankle) anteroposterior radiographs were taken postoperatively to measure the mechanical angle, tibial component angle, femoral component angle, physiologic valgus angle, and tibiofemoral angle. No significant differences between the extramedullary and intramedullary groups were found; each system allowed satisfactory alignment. It is important for the surgeon to appreciate the benefits and deficiencies of each guide and to use whichever is suited most properly in each particular case.

Adult↗
PubMed1994

Results of nonmetal-backed, high-density polyethylene, biconvex patellar prostheses. A 5-7-year follow-up evaluation.

This study evaluates the clinical and radiographic results of an all-polyethylene, biconvex, dome-shaped patellar prosthesis with precise instrumentation implanted in 53 knees with a minimum follow-up period of 5 years (average, 6.3 years; range, 5.0-7.1 years). The mean patient age was 70.9 years (range, 18.0-89.0 years). The mean Hospital for Special Surgery knee rating score was 63.6 before surgery and 83.4 after surgery. There was no fracture of the patella, no implant failure, or radiographic loosening of the prosthesis. Patellar complications consisted of two dislocations secondary to trauma and one case of patellar subluxation. Several radiographic parameters were measured. Means and SDs were computed for: (1) patellar tilt, as measured from a line between the anterior limits of the femoral condyles and the patella, which showed no significant difference after surgery (3.01 degrees +/- 5.12 degrees) compared to before surgery (3.73 degrees +/- 5.44 degrees); (2) the angle between the patellar component and the residual bone was -0.04 degrees +/- 2.04 degrees, with every case in the normal range (+/- 5 degrees); (3) there was no significant difference between pre- and postoperative patellar length, patellar thickness, or articular length of the patella; (4) the patellar height showed a small but statistically significant difference after surgery (2.69 +/- .64 cm) and before surgery (2.94 +/- .72 cm); (5) the distance from the tibial tubercle to the joint line did not differ significantly between preoperative (2.73 +/- 0.34 cm) and postoperative (3.06 +/- 0.36 cm) measurements; and (6) the distance from the center of the tibial plateau to the center line of the tibial prosthesis was 1.34 +/- 0.32 cm. These results are superior to previously reported series.

Aged↗
PubMed1994

Nonconstrained implants in revision total knee arthroplasty.

From March 1989 to March 1992, 39 knees were studied in 36 patients who had undergone revision total knee arthroplasty. A posterior stabilized modular prosthesis was used in 31 knees, and a standard condylar modular prosthesis was used in 8. Average followup was 20 months. The mean tibiofemoral angle was 2.1 degrees valgus (range, 22 degrees varus-23 degrees valgus) preoperatively, and 5.9 degrees valgus (range, 2 degrees varus-14 degrees valgus) postoperatively. Component placement in anteroposterior and lateral view was improved postoperatively. Postoperative patellar height was normal in 63.6% of the knees. Partial radiolucent lines were present in at least 1 prosthetic component in 72.7% of the knees, but no lines were complete. The Knee Society Pain Score improved from 50.5 points preoperatively to 82.7 points postoperatively. The Knee Society Function Score improved from 35.5 points to 56.1 points. Complications occurred in 20.5%. Since then, there has been 1 failure, an infection that subsequently led to knee fusion. Revision total knee arthroplasty presents difficult challenges, such as bone loss and ligamentous instability. A modular total knee replacement system allows the surgeon to do accurate preoperative planning and also to tackle unexpected problems intraoperatively. The authors' early results of revision total knee arthroplasty using a modular semiconstrained system are satisfactory.

Aged↗
PubMed1992

Patellar tendon rupture. Description of a simplified operative method for a current therapeutic problem.

A simple operative method for the treatment of patellar tendon rupture is introduced. The operative procedure is described and we present the short-term results of the first seven patellar tendon ruptures that have been treated accordingly at our clinic. The technique is easily reproducible and utilizes a minimum of foreign body implant. A secondary procedure for removal of suture material is rarely necessary.

Adult↗
PubMed1992

The effect of stainless steel, cobalt-chromium, titanium alloy, and titanium on the respiratory burst activity of human polymorphonuclear leukocytes.

Although infection is a serious complication associated with the use of orthopedic prosthetic implants, the impact of the metal used in these devices on host defense is poorly understood. The authors investigated the effect of stainless steel, titanium, titanium alloy, and cobalt-chromium alloy on the respiratory burst of polymorphonuclear leukocytes (PMN), a vital component of bactericidal activity. In the presence of stainless steel powder or supernatants obtained from the incubation of stainless steel in buffer, superoxide production by PMN was significantly impaired. Titanium, titanium alloy, and cobalt-chrome alloy had no significant effect on superoxide production. Nickel and chromium, the only metal ions detectable in the stainless steel supernatant, did not impair superoxide production when tested at concentrations similar to those found in the supernatant. Inhibition of PMN superoxide production may play a role in the establishment and persistence of stainless steel device-related infections.

Cell Survival↗
PubMed1991

Suppressive antibiotic therapy in chronic prosthetic joint infections.

Thirteen patients with chronic total joint infections (eight knees, five hips) were treated with suppressive antibiotic therapy and retention of the prosthesis following surgical debridement and 4 to 6 weeks of intravenous antibiotic therapy. These patients faced poor functional outcome after prosthesis removal. After a mean follow up of 37.6 months (range: 24 to 55), only three patients have retained their prostheses. Ten patients required prosthesis removal for recurrent infection a mean of 21.6 months (range: 6 to 48) after starting suppressive therapy. In addition, 38% of patients experienced adverse effects which led to changes in the antibiotic regimen. Suppressive antibiotic therapy in the treatment of chronic prosthesis infections has limited clinical efficacy and is associated with a substantial risk of adverse effects.

Anti-Bacterial Agents↗
PubMed1991

The timing of flap coverage, bone-grafting, and intramedullary nailing in patients who have a fracture of the tibial shaft with extensive soft-tissue injury.

The cases of forty-three patients who had a Type-IIIB open fracture of the tibial shaft were reviewed to determine the effect of treatment of the soft-tissue injury on the rate of major complications. An infection developed in two of the eleven patients who had had early muscle-flap coverage compared with ten of the nineteen who had been managed by open care of the wound and nine of the thirteen who had had later flap coverage. Patients who had had bone-grafting after complete re-epithelialization of the wound, regardless of the method of closure, had a lower rate of early infection (none of sixteen compared with four of fifteen) and an earlier average time to union (fifty-four compared with sixty-three weeks) than those in whom the wound was not completely closed or was draining at the time of bone-grafting. Delayed intramedullary nailing with reaming was associated with a high rate of infection (nine of nineteen patients), regardless of the condition of the soft tissue at the time of nailing. In our opinion, adequate débridement and early assessment of the soft-tissue defect are necessary so that appropriate soft-tissue coverage can be provided within the first one to two weeks. When the soft-tissue portion of the injury is addressed promptly and definitively and then allowed to heal completely, secondary osseous reconstruction may proceed with fewer complications.

Adult↗
PubMed1991

Effect of time of onset and depth of infection on the outcome of total knee arthroplasty infections.

The treatment results of 24 infected total knee arthroplasties with a minimum follow-up period of two years are presented. The most common pathogens were coagulase-positive staphylococci (50%), coagulase-negative staphylococci (29.2%), and enterococci (12.5%). Eleven patients with early postoperative infections (occurring within one month of prosthesis implantation) were treated with debridement, retention of the prosthesis, and intravenous antibiotics. Treatment was successful in all five patients with superficial infections not extending into the joint. In six patients with deep infections, treatment was successful in only two (33%), despite a longer course of antibiotic therapy (four to six weeks) and the use of tobramycin-impregnated polymethylmethacrylate beads. Three patients continued to have recurrent drainage, and one patient was subsequently successfully treated with a delayed exchange arthroplasty. Thirteen patients were diagnosed with late infections. One patient with a late, superficial infection and another with an acute (hematogenous seeding), deep infection were successfully managed with debridement and intravenous antibiotics. Prosthesis removal was not required. Eleven patients presented with late, deep infections. Of three patients who were treated without removal of the prosthesis, infection was arrested in only one. The remaining eight patients were treated with debridement, intravenous antibiotics, tobramycin-impregnated polymethylmethacrylate beads, and delayed exchange arthroplasty. The median interval to reimplantation was eight weeks (range, seven to 25 weeks). Treatment was successful in six cases (75%). The overall success rate in the treatment of total knee arthroplasty infections was 71%. In 19 patients with deep infections, treatment success was seen in 78% of patients treated with delayed exchange arthroplasty, but this value was only 40% in patients who were not treated with prosthesis removal.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

Stability of initial fixation of the tibial component in cementless total knee arthroplasty.

This study measured the vertical displacement of three kinds of cementless tibial components [Porous Coated Anatomical (PCA), Tricon, and Whiteside], under eccentric loading up to 2,225 N. Displacement between the tibial tray and the proximal tibia was measured with linear variable differential transformers at the anterior and posterior side when anteriorly or posteriorly loaded, and at the medial and lateral side when medially or laterally loaded. The general pattern of motion was sinking at the loaded side and lift-off at the opposite side. Lift-off opposite the loaded side was fairly small for all components at all measurement sites. Among the three components, the Whiteside showed the smallest displacements. The Tricon (when anteriorly or posteriorly loaded), and the PCA (when medially or laterally loaded) showed sinking at the loaded side. Anterior screw fixation of the PCA was not effective in preventing anterior lift-off. The tilting motion of the tibial components observed in this study implies instability of the initial fixation, which could possibly compromise bony ingrowth. Furthermore, this tilting could cause uneven distribution of load, and potentially result in fracture of the underlying bone.

Bone Screws↗
PubMed1990

Combined orthopedic and vascular injury in the lower extremities: indications for amputation.

A retrospective review was undertaken to determine risk factors associated with amputation after open fractures of the lower extremity that were complicated by vascular injury. During an 11-year period ending in December 1987, we observed open fractures in 31 patients and injuries to the popliteal artery in 16 patients, to the tibial arteries in eight patients, to the femoral artery in five patients, and to the dorsal artery of the foot in two patients. Vascular repair was accomplished in 25 patients; 12 patients had primary end-to-end anastomosis, 12 patients had reverse saphenous vein grafts, and one patient had a bovine graft. Of these 25 patients, five patients required amputation because of infection and three patients required amputation because of continued ischemia. Three patients with irreparable damage had immediate amputation, and three patients without distal ischemia had vessel ligation only. The risk factors associated with amputation were shock on admission (10 of 19 patients [p less than 0.02]) and a crushed extremity (10 of 18 patients [p less than 0.01]). The overall amputation rate, which included three immediate amputations and eight late amputations, was 35.2%. The data suggest that limb salvage is possible in two thirds of patients with combined orthopedic and vascular injuries of the lower extremity, but a history of shock or crush injury with vascular compromise is an unfavorable prognostic sign.

Accidents, Traffic↗
PubMed1989

Rationale, experience, and results of long-stem femoral prosthesis.

A long, curved-stem, uncemented femoral component was evaluated for use in primary and revision hip arthroplasty in young patients aged 43.5 years (range, 16-60 years). The femoral component has a proximal wedge shape and a medial collar for proximal press fit and load transfer; anterior and posterior ingrowth pads; anteverted head and neck; and a long, anatomically curved intramedullary stem for distal stability. In testing the contribution of the long, curved stem to the torsional stability of uncemented prostheses by comparing it with other stems, the long, curved stem was the most stable, followed by a shorter straight stem, and a short, proximally curved stem. If the long, and a short, proximally curved stem. If the long, curved stem is incrementally shortened by 1.5-7.5 cm, the initial torsional stability is reduced in proportion to the amount of shortening. Geometrically, for a given patient, the stem-bone contact (and thus the distal stability) is increased when a larger stem is inserted. Clinically, Harris hip scores in 69 hips followed for five to seven years (average patient age, 43.5 years) improved from 52.6 to 92.0 at last follow-up evaluation. The femoral component revision rate was 2.9%, the acetabular rate was 8.9%, and bipolar revision rate was 3.1%, for a combined rate of 12%.

Adolescent↗
PubMed1989

Infection after intramedullary nailing of severe open tibial fractures initially treated with external fixation.

Twenty-four patients had a severe open fracture of the tibia that was initially treated by external fixation and subsequently by reamed intramedullary nailing. The external fixation had been maintained for an average of fifty-two days (range, seven to 230 days). The mean interval between removal of the external fixator and intramedullary nailing was sixty-five days (range, three to 360 days). In five of the seven patients who had had an infection at one or more of the pin sites, an infection later developed around the intramedullary nail. In comparison, only one of the seventeen patients who had not had a pin-site infection had an infection later around the nail (p = 0.003). An analysis of other variables, including the duration of external fixation, wound coverage, other injuries, and the type of fracture, showed that none was a predictor of infection either at the pin sites or around the intramedullary nail. We concluded that a pin-site infection that develops during external fixation is a contraindication to the subsequent use of reamed intramedullary nailing in patients who have a fracture of the tibia.

Adolescent↗
PubMed1989

Rotational stability of diaphyseal fractures of the radius and ulna fixed with Rush pins and/or fracture bracing.

The rotational stability of fractures of the radius and ulna treated with Rush pins and/or fracture bracing was studied in six fresh cadaver forearms. Forearm rotation and fracture site motion (rotation) were measured as functions of applied forearm torque and rotation (pronation-supination). Values were obtained from the forearm: (1) intact and with both bones fractured; (2) without fixation; (3) with a fracture brace; (4) with Rush pins; and (5) with a combination of Rush pins and a fracture brace. A brace was ineffectual in reducing fracture site motion when the wrist was rotated to specified angles compared to fracture site motion for the forearm with no fixation treatment rotated to the same angles. When loading to specific torque levels, however, the brace reduced fracture site motion to one-half the motion with no fixation treatment. Under both loading conditions, Rush pin fixation significantly and markedly reduced the fracture site motion (to approximately one-eighth of the motion with no fixation treatment), whereas a brace in conjunction with Rush pins did not significantly further reduce the fracture site motion. The radius showed more motion at fracture site than the ulna.

Bone Nails↗
PubMed1988

The effect of anaerobiosis on antistaphylococcal antibiotics.

The activity of eight antimicrobial agents which might be used in the treatment of staphylococcal osteomyelitis was tested under anaerobic conditions similar to those found in chronically infected bone. An agar-dilution method was employed to determine the minimum inhibitory concentrations of tobramycin, vancomycin, teicoplanin, ciprofloxacin, clindamycin, ceftriaxone, ticarcillin-clavulanic acid, and amoxicillin-clavulanic acid against 25 coagulase-positive and 25 coagulase-negative staphylococcal strains. The activity of tobramycin against coagulase-positive staphylococci, and of amoxicillin-clavulanic acid and ticarcillin-clavulanic acid against coagulase-negative staphylococci was markedly decreased with anaerobiosis. Vancomycin, teicoplanin, and ciprofloxacin were active against coagulase-positive and coagulase-negative staphylococci under both aerobic and anaerobic conditions. It was also found that antibiotic concentrations comparable to the high levels which might be achieved with local antibiotic therapy of osteomyelitis were not sufficient to overcome the level of resistance (100 micrograms/ml) of staphylococci which were not susceptible to tobramycin, clindamycin, ceftriaxone, and ticarcillin-clavulanic acid.

Amoxicillin↗