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Biomedical subjects

R E Windsor

Publications and source records attributed to R E Windsor.

36 records · Page 2Linked to original sources
PubMed1990

Bone-block iliotibial band reconstruction for anterior cruciate insufficiency. Follow-up note and minimum five-year follow-up period.

Sixty-two of 71 patients (87%) who received a bone-block iliotibial band transfer were followed with a minimum follow-up period of five years (range, 5-10 years). Sixteen of the originally studied knees were examined with an average follow-up period of 104 months (range, 90-120 months). A second group of 46 knees was studied at an average follow-up period of 75 months (range, 60-92 months). Preoperatively, all patients had giving way (buckling). The average postoperative score of the original group was 83 (range, 52-99 points). There were nine excellent, three good, and four poor results. The average postoperative score of the second group was 89 (range, 73-99 points). There were 24 excellent, 18 good, and four fair results. Giving way was absent in 93% of the patients postoperatively; 88% had a negative pivot-shift test. Sixty-eight percent of the patients no longer used a brace for sports, 24% wore a brace for protection only, and 8% used it for instability. Improvement of at least one grade in the Lachman and anterior drawer tests was found in 61% and 85% of the patients, respectively. Pain was the major reason for fair and poor results. All but one had previous meniscectomy. There were no fair or poor results with menisci intact. So far, there has been no deterioration with time. The procedure remains ideal for recreational athletes who cannot afford a long absence from work and for those patients whose daily activities are compromised by recurrent knee instability.

Activities of Daily Living↗
PubMed1990

Two-stage reimplantation for the salvage of total knee arthroplasty complicated by infection. Further follow-up and refinement of indications.

Thirty-eight total knee replacements (in thirty-five patients) that were complicated by infection were treated with a two-stage protocol for reimplantation. The clinical results in these knees (nine of which have been previously reported on) were evaluated at an average follow-up of four years (range, 2.5 to ten years). There was only one documented recurrence of infection with the original organism. Three patients in whom the immunological system was suppressed had a subsequent hematogenous infection with a different organism. According to the knee-rating system of The Hospital for Special Surgery, there were eleven excellent, thirteen good, six fair, and seven poor results. For one patient who had severe polyarticular rheumatoid arthritis, the result could not be rated. The results of this study suggested that the two-stage protocol for reimplantation, with a six-week interval of intravenous antibiotic therapy, is the procedure of choice for the treatment of an infection around a total knee arthroplasty. A patient who has polyarticular rheumatoid arthritis and in whom the immunological system is suppressed may not be an ideal candidate for the protocol. Gram-negative bacterial infection may be treated with this protocol, provided the organism is sensitive to relatively non-toxic antibiotic medication.

Aged↗
PubMed1990

Pneumatic sequential-compression boots compared with aspirin prophylaxis of deep-vein thrombosis after total knee arthroplasty.

This prospective, randomized study was undertaken to compare the effectiveness of pneumatic sequential-compression boots with that of aspirin in preventing deep-vein thrombosis after total knee arthroplasty. Patients were randomly assigned to one of two prophylactic regimens: compression boots or aspirin. One hundred and nineteen patients completed the study. Seventy-two patients had unilateral arthroplasty and forty-seven, one-stage bilateral arthroplasty. In the unilateral group, the incidence of deep-vein thrombosis was 22 per cent for the patients who used compression boots compared with 47 per cent for those who received aspirin (p less than 0.03). In the bilateral group, the incidence of deep-vein thrombosis was 48 per cent for the patients who used compression boots compared with 68 per cent for those who received aspirin (p less than 0.20). The results confirm the effectiveness of compression boots in the treatment of patients who have had unilateral total knee arthroplasty. Despite the use of compression boots, however, patients who had bilateral arthroplasty were at greater risk for the development of deep-vein thrombosis.

Aged↗
PubMed1989

Patellar fractures in total knee arthroplasty.

The incidence of patellar fractures following total knee arthroplasty varies from 3% to 21%. This problem has been attributed to avascular necrosis of the patella secondary to the surgical approach, including medial arthrotomy and lateral release, patellar bone resection, thermal necrosis, and anatomic variation. Management of these patellar fractures may be conservative or surgical.

Bone Wires↗
PubMed1989

Arthroplasty for the stiff or ankylosed knee.

Twenty stiff (range of motion, less than 50 degrees) and six ankylosed knees were replaced with the posterior stabilized condylar prosthesis and evaluated after an average of 4.5 years (range, 2.5-7.5 years). There were 81% good to excellent, 11.5% fair, and 7.5% poor results. The maximum overall degree of flexion improved from an average of 60 degrees before surgery to 85 degrees after surgery. Flexion contracture was reduced from 28 degrees to 7 degrees, and the total arc of motion significantly increased from 32 degrees to 78 degrees. Less motion was achieved in the ankylosed knees. A modified inverted V-Y quadricepsplasty was a useful approach to the knee in 11 cases.

Adult↗
PubMed1989

Mechanisms of failure of the femoral and tibial components in total knee arthroplasty.

From 1974 to 1986, 1430 cemented primary total knee arthroplasties were available for analysis. These included 224 total condylar prostheses with a polyethylene tibial component, 289 posterior stabilized prostheses with a polyethylene tibial component, and 917 posterior stabilized prostheses with a metal-backed tibial component. There were 12 failures in the total condylar series including three infections (one early and two late), five loose tibial components, two loose femoral and tibial components, and two unstable arthroplasties. The posterior stabilized prosthesis with the polyethylene tibia demonstrated six failures including two loose tibial components, two loose femoral components, and one supracondylar femur fracture. The posterior stabilized prosthesis with the metal-backed tibial component was associated with seven failures including six infections (three early and three late) and one femoral loosening. No metal-backed tibial components have been revised for loosening. The overall failure rate in this series was 1.7% for all prostheses. The incidence of tibial loosening was 0.53% with an average time to failure of 4.7 years. The incidence of femoral loosening was 0.35% with an average time to failure of 2.0 years. Tibial loosening was related to error in technique: postoperative varus tibiofemoral alignment, varus tibial component position, and excessive tibial resection. The overall infection rate was 0.63% for all total knee arthroplasties, and all were secondary to gram-positive organisms. Presently, the posterior stabilized prosthesis with a metal-backed tibia is the authors' implant of choice. Technical error and infection are the major causes of failure.

Aged↗
PubMed1989

Total knee arthroplasty in patients with psoriasis.

Patients with progressive psoriasis have an increased infection rate when having total joint arthroplasty. Therefore, maximum precautions should be taken in the perioperative period as well as with long-term follow-up care to prevent joint sepsis in these patients. In particular, skin care should be meticulous. Special attention should be given to use of a topical corticosteroid or other dermatologic treatment when total joint arthroplasty is considered.

Anti-Bacterial Agents↗
PubMed1989

Survivorship of cemented knee replacements.

The survivorship method of analysis has been used to compare the failure rate and overall success of 1,430 cemented primary total knee arthroplasties performed at The Hospital for Special Surgery over a 15-year period. There were 224 total condylar prostheses with a polyethylene tibia, 289 of the posterior stabilised type with an all polyethylene tibia, and 917 posterior stabilised with a metal-backed tibial component. There were 12 failures in the total condylar series, giving an average annual failure rate of 0.65% and a 15-year success rate of 90.56%. The posterior stabilised prosthesis with a polyethylene tibia showed an average annual failure rate of 0.27% and a 10-year success rate of 97.34%, and this prosthesis with a metal-backed tibial component gave an annual failure rate of 0.19% and a seven-year success rate of 98.75%. The overall survival rate was not influenced by sex or age, diagnosis or the percentage of ideal body weight. No metal-backed tibial components have yet needed revision for loosening. It seems that infection will be the major cause of failure.

Adult↗
PubMed1989

Contralateral total hip arthroplasty or ipsilateral total knee arthroplasty in patients who have a long-standing fusion of the hip.

We studied the cases of twenty patients who had had an ipsilateral total knee arthroplasty or a contralateral total hip arthroplasty, or both, long after one hip had been fused in an acceptable position. Between 1972 and 1986, we performed twenty-one total joint arthroplasties (on thirteen hips and eight knees) and followed two additional patients (one hip and one knee) in whom the operation had been performed elsewhere. The average age of the patients at the time of arthroplasty was fifty-seven years (range, thirty-one to eighty-one years), and the average time from arthrodesis to arthroplasty was thirty-two years (range, eleven to fifty-four years). The results of eighteen of the twenty-three arthroplasties were evaluated at an average of seven years and nine months postoperatively. Four of the remaining five patients, who were followed for an average of eight years, died of a cause that was unrelated to the arthroplasty. After the hip arthroplasty, five hips were rated excellent; five, good; one, fair; and three, poor. Each hip that had a poor result was revised twice for mechanical loosening. Three hips for which the result was not considered poor had progressive radiolucency. After the knee arthroplasty, three knees were rated excellent; four, good; one, fair; and one, poor (because of infection). Seven knees were manipulated a total of fifteen times. Only one patient had progressive symptomatic radiolucency, nine years after the insertion of a posterior stabilized prosthesis. Clinically important ligamentous instability was not encountered.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Observations on patellar height after proximal tibial osteotomy.

Sixty-six knees (sixty patients) that had had a proximal tibial osteotomy were evaluated to determine if any alteration of the patellar height had occurred as a result of the operation. Eighty-nine per cent of the patellae, as measured by the Insall-Salvati index, and 76.3 per cent, as measured by the Blackburne-Peel index, were observed to be lowered as they appeared on the postoperative lateral radiograph. This was probably due to shortening of the patellar ligament after prolonged immobilization in a cast, interstitial scarring of the patellar ligament, and new-bone formation in the area of insertion of the patellar ligament. There was no correlation between the postoperative height of the patella and the need for subsequent revision to a total knee replacement.

Humans↗
PubMed1988

Anabolic steroid use by athletes. How serious are the health hazards?

Use of anabolic steroids is widespread in the athletic community, especially among power athletes, who have used them for about 30 years. Despite educational and preventive measures, steroid use has increased. Controversy continues regarding the enhancement of athletic performance and the incidence of major side effects. Some investigators have suggested that the hazards of anabolic steroids may be overstated in the diseased population and are minimal or absent in healthy subjects. Yet, many questions are unanswered. Current data do not link life-threatening side effects with intermittent use of anabolic steroids. However, many concerns remain. Dangerous situations include use of anabolic steroids by adolescents, preadolescents, and persons with liver or heart disease and use of oral compounds in high doses for long periods. A coordinated team approach (with representatives from sports, medicine, advertising, and the pharmaceutical industry) is needed to determine the real risks of anabolic steroids to athletes who are considering their use.

Anabolic Agents↗
PubMed1988

Revision of well-fixed cemented, porous total knee arthroplasty. Report of six cases.

Revision of cemented, porous ingrowth total knee arthroplasties poses several technical problems that are unique to these implants, especially component extraction. Six cases are presented to illustrate these difficulties, with particular attention given to revision techniques. The revisions were performed not for aseptic loosening but for causes in which all the implants were securely affixed to bone. To avoid large amounts of bone loss during extraction, the cement-prosthesis interface should be disrupted with high-speed instruments, such as a high-speed burr or oscillating saw. The tibial component may need to be disassembled to gain access to the tibial fixation peg. The potential problems of revision of cemented, porous total knee implants may necessitate bone grafting or custom-designed prostheses.

Aged↗
PubMed1988

Technical considerations of total knee arthroplasty after proximal tibial osteotomy.

Forty-five total knee replacements in forty-one patients who had continued to have progressive osteoarthritis after a proximal tibial osteotomy were evaluated prospectively. There were 51 per cent excellent, 29 per cent good, 4 per cent fair, and 16 per cent poor results after a minimum follow-up of two years. The resection of tibial bone that was produced by the osteotomy could not be related causally to the fair or poor clinical results that were found after arthroplasty. Radiographic study, however, showed that 80 per cent of the knees had patella infera before the arthroplasty, which may contribute to altered biomechanics of the patellofemoral joint of the arthroplasty. The procedure for total knee replacement is made more difficult by the previous osteotomy, and a custom-made prosthesis may be required. The clinical results that were obtained in this series are similar to those for the revision total knee arthroplasties that have been done at this institution, but they were not as satisfactory as those that were obtained after primary total knee replacement. Our results should be considered when a surgeon compares the advantages and disadvantages of proximal tibial osteotomy with those of total knee arthroplasty for an older patient who has unicompartmental osteoarthritis of the knee.

Adult↗
PubMed1987

Long-term results after total condylar knee arthroplasty. Significance of radiolucent lines.

In a prospective study of 123 total condylar knee arthroplasties, radiolucent lines were noted at the bone-cement interface about the tibial component in 65% of the knees. In 36%, the line was thin (less than 2 mm) and under either the medial or lateral tibial plateau. In 22%, thin lines were seen under both the medial and lateral plateaus. There was no statistically significant correlation between the occurrence of thin radiolucent lines in any location and the eventual postoperative clinical result. In 7%, thick lines (greater than 2 mm) were noted about the central peg of the prosthesis as well as under both plateaus and were associated with poor results. A 1-mm radiolucent interface was attached to various tibial components, which were then cemented into cadaver knees. For the polyethylene total condylar component, flexion or rotation of the prosthesis more than 5 degrees, angulation of the roentgen beam more than 6 degrees, or offsetting the beam more than 2.5 cm prevented visualization of the radiolucent line. With metal-backed components, more than 4 degrees of flexion obscured the lines. Therefore, extremely careful positioning of postoperative radiographs is essential for evaluating radiolucent lines after total knee arthroplasty.

Aged↗
PubMed1987

Correction of valgus knee deformity with a supracondylar V osteotomy.

Valgus deformities at the knee can be successfully corrected with V-shaped supracondylar osteotomy. The advantages of this relatively simple technique are low morbidity, good stability with early weight-bearing, no need for internal fixation, and ability to adjust alignment with postoperative cast. Healing is relatively rapid (two months), and the range of motion returns (two months after cast removal) to preoperative values. This technique proved useful for deformities in both young and old patients with osteoarthritis. This is a preliminary report of the surgical technique, postoperative management, and short-term results of a prospectively evaluated series of 14 consecutive cases.

Casts, Surgical↗
PubMed1986

Bone grafting of tibial defects in primary and revision total knee arthroplasty.

Bone grafting of tibial defects in primary and revision total knee arthroplasty is performed by at least two different methods, preferably with local autogeneic bone. Incorporation of the graft occurs between four and eight months. No restriction in weight-bearing is recommended, except with repair of large defects. Bone grafting is a viable alternative to using custom tibial prostheses or excess cement, even for very large defects.

Bone Nails↗
PubMed1985

Fracture healing in the rabbit fibula when subjected to various capacitively coupled electrical fields.

The effect of capacitively coupled electrical stimulation on the healing of midshaft transverse osteotomies of the rabbit fibula is assessed roentgenographically, mechanically, and histologically. The results show that a dose-response curve for capacitive coupling and fracture healing exists and that a 220 mV, 250 microA, 60 kHz applied electrical signal (0.33 V/cm internal electric field) is the most effective signal for fracture stimulation in this model.

Animals↗