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Biomedical subjects

R H Cofield

Publications and source records attributed to R H Cofield.

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

Humeral head replacement for glenohumeral arthritis.

From July 1977 through March of 1983, humeral head replacement was performed on 35 shoulders with osteoarthritis and 32 shoulders with rheumatoid arthritis and followed-up for an average of 9.3 years. Satisfactory pain relief was achieved in 44 (66%) and 52 of the shoulders (78%) were described by patients as being much better or better. Active elevation was improved from an average of 84 degrees to an average of 110 degrees with external rotation improving from 20 degrees to 44 degrees. Strength improvement also occurred. Only three complications developed, and these did not affect the final outcome. Because of moderate or severe pain, 12 shoulders (18%) required revision to total shoulder arthroplasty, and all patients were relieved of their pain. The result ratings were excellent in 10 shoulders, satisfactory in 23, and unsatisfactory in 34 (51%). With longer follow-up, a satisfactory level of pain relief may not continue for those patients with osteoarthritis and rheumatoid arthritis who have had humeral head replacement alone. Whereas this form of treatment should certainly be considered in those patients who have inadequate glenoid bone to support a glenoid implant and probably be considered in younger patients or patients who wish to remain more active, these latter patients must be fully appraised that the probability of continuing pain relief is less than has often been appreciated.

Adult↗
PubMed1994

Uncemented total shoulder arthroplasty. A review.

Clinicians have had much experience with uncemented humeral components. A press-fitted humeral component will usually remain stable in the absence of a glenoid component. From the information available, surgeons should not continue to use press-fitted humeral components for total shoulder arthroplasty. Tissue ingrowth humeral components offer promise; however, the reports to date have short or intermediate length followup, and radiographic results do not equal those of cemented components. Early clinical results with tissue ingrowth glenoid components are excellent; radiographically evident changes occur much less frequently than they do following cement fixation. However, their disadvantage is the possibility of accelerated polyethylene wear and subsequent metal-induced synovitis. As such, there are no clear cut indications for cement fixation versus tissue ingrowth fixation for the glenoid component other than those intuitively based on bone quality and quantity in the glenoid fossa. Accruing experience will help to define the indications better, but given the similarity of clinical outcomes to date, distinction between the options may be difficult.

Arthroplasty↗
PubMed1994

Massive subacromial bursitis with rice bodies. Report of three cases, one of which was bilateral.

Multiple cartilaginous-like bodies (rice bodies) in joints or bursae may be the presenting sign of a more extensive underlying rheumatic condition. Three patients with massive subacromial bursae with rice bodies are described, one of whom had bilateral occurrence. In all patients, excision of the bursa and rice bodies relieved the symptoms. The underlying rheumatic condition continued its course, generally sparing the involved shoulder joint. Review of these cases reinforces the need to provide a thorough examination for systemic rheumatologic disease in patients diagnosed with this lesion.

Acromioclavicular Joint↗
PubMed1993

Open reduction and internal fixation of displaced intra-articular fractures of the glenoid fossa.

Ten displaced intra-articular fractures of the glenoid fossa were treated with open reduction and internal fixation between 1980 and 1987. Nine patients were available for evaluation at an average of four years (range, two to ten years) after the operation. Eight patients had mild or no symptoms and little or no restriction of the motion of the shoulder. There were no infections or malunions. The only complication was heterotopic ossification in one patient. Radiographic evaluation showed no evidence of traumatic osteoarthrosis in any patient. Open reduction and internal fixation is a useful and safe technique for the treatment of selected, displaced fractures of the glenoid fossa, and it can restore excellent function of the shoulder.

Adult↗
PubMed1993

Diagnosis of shoulder instability by examination under anesthesia.

A systematic method of examining the shoulder in anesthetized patients was developed. Humeral translocation on the glenoid was assessed in five directions and in three positions of arm rotation for four of these directions. Fifty-five patients thought to have shoulder instability were evaluated by history taking, physical examination, standard and special roentgenograms, examination under anesthesia, and either shoulder arthroscopy or operation. The findings at examination under anesthesia were compared with the pathologic conditions identified at arthroscopy or operation. Twenty-five shoulders had pathologic evidence of continuing instability: Bankart lesions in 19 and clearly excessive capsular laxity in six. All 25 had abnormal results on examination under anesthesia (no false-negative results). Thirty shoulders had no demonstrable pathologic condition. The results of examination under anesthesia were normal for 28 shoulders and abnormal for two (two false-positive results). The sensitivity of examination under anesthesia in these patients was 100%. The specificity and predictive value were 93%. Examination under anesthesia has proven to be reasonably precise in assessing shoulder stability. If the results of the examination are normal, more complex and invasive diagnostic testing may not be necessary.

Adolescent↗
PubMed1990

Integral surgical maneuvers in prosthetic shoulder arthroplasty.

Total shoulder arthroplasty has advanced beyond addressing only the techniques of implant placement. To improve clinical results and assure maximum implant longevity, the surgeon needs to address soft tissue contractures, soft tissue deficiencies, glenohumeral instability, and bone deficiencies with a number and often a combination of surgical maneuvers. These techniques include excision of abnormal tissue, division of adhesions, selective tissue releases, variation in bone osteotomy or preparation to modify implant position, use of a variety of standard implants or custom devices, and supplementation of certain tissue deficiencies with autologous or allograft tissues. When the reconstruction is completed, the surgeon needs to assess movement, stability, and strength of the supporting tissues to plan an optimal rehabilitation program.

Contracture↗
PubMed1990

Total shoulder arthroplasty: complications and revision surgery.

Fortunately, revision surgery after prosthetic shoulder arthroplasty is rarely required. However, various complications or combinations of complications can lead to the need for revision surgery. For many of these, several treatment options are possible. Recognizing all the problems that contributed to failure in an individual patient may be difficult before revision surgery. Understanding the abnormality present at the time of surgery requires considerable experience. For example, glenoid loosening, in addition to being accompanied by scapular bone loss, may be associated with rotator-cuff tearing, instability, or joint contracture. In addition to the component loosening, all of these must also be treated if the revision procedure is to be successful. When addressing glenoid loosening, it seems to be best to revise the component, if possible. If there is extreme bone loss, one may have to bone graft the deficiencies and not replace the glenoid component. Fortunately, clinically significant humeral loosening is rare. When it occurs, revision of the component is justified and almost always possible. In hemiarthroplasties with pain, conversion to a total shoulder arthroplasty by placing a glenoid component is highly effective. In instability after shoulder arthroplasty, soft-tissue repair does not always create stability. Unfortunately, for most patients, component revision is a necessary part of the revision surgery. When rotator-cuff tearing is acute, repair is indicated; for chronic rotator-cuff tearing, repair depends on the severity of the symptoms. When infection develops after shoulder arthroplasty, implant removal is almost always necessary, but occasionally, in low-grade infections, a primary or secondary exchange procedure may be possible.

Humans↗
PubMed1990

Anterior acromioplasty for treatment of the shoulder impingement syndrome.

Between 1975 and 1979, anterior acromioplasty was performed in 65 patients with 66 involved shoulders. The procedure appears to be safe and reasonably effective. Of the 65 patients in this study, 50 had chronic tendon inflammation with fibrosis, and 16 also had a small supraspinatus tendon tear. These 16 had rotator cuff repairs. Twenty-six patients were also treated with distal clavicle excision, and seven had tenodesis of the long head of the biceps brachii. The average age of the patients was 50 years (range, 23-75 years). All patients were followed for an average of eight years (range, three to 13 years). At final evaluation, no or slight pain was present in 77% of the shoulders: 39 of 50 without tendon tearing and 12 of 16 with tendon tearing and repair. Active shoulder abduction averaged 167 degrees. Ninety-two percent returned to employment, including 18% with some job modification. Eighty-six percent returned to recreational athletics, 20% with some modification of activities. Seven patients had additional surgical treatment. The progression of rotator cuff disease is not always prevented, but the need for subsequent shoulder treatment generally decreases.

Acromion↗
PubMed1989

Tenodesis of the long head of the biceps brachii for chronic bicipital tendinitis. Long-term results.

Fifty-four shoulders in fifty-one patients were followed for an average of thirteen years (range, two to twenty-three years) after surgical tenodesis of the long head of the biceps brachii for the treatment of chronic tendinitis. At an average of six months postoperatively, in all but three shoulders (forty-eight patients) some benefit was evident. However, after a longer follow-up, a satisfactory result was achieved in only twenty-eight shoulders (approximately 50 per cent). About one-third of the shoulders continued to be pain-free, and in eight shoulders (15 per cent) an additional operation was performed. Tenodesis of the long head of the biceps tendon, therefore, was not an effective treatment for tendinitis over the long term.

Adult↗
PubMed1988

Ingrown toenail: results of surgical treatment.

When an ingrown toenail is unresponsive to simple treatment methods, surgical treatment options are available. At our institution, 100 patients with 142 affected toes were surgically treated by one of five techniques and observed for a mean of 9.7 years (range, 7.8 to 10.0 years). Plastic nail wall reduction was effective (four of four nail edges) for mild disease. After marginal nail excision with chemical matrix ablation, the recurrence rate was 20% (12 of 61 nail edges); eight required further surgical treatment. Marginal nail excision combined with surgical excision of the associated nail matrix (Heifetz procedure) was more successful: recurrence occurred in only 6% (6 of 95 nail edges), and only one toe required further surgical treatment. For severe nail deformity, nail ablation with matrix excision (Zadik procedure) was followed by recurrence in 33% (three of nine toes); all three required additional surgical treatment. After terminal amputation (Lapidus/Thompson-Terwilliger procedure), the recurrence rate was 12% (2 of 17 toes); only one nail required additional surgical treatment.

Follow-Up Studies↗
PubMed1988

Biomechanical analysis of stability and fixation strength of total shoulder prostheses.

The Neer I (polyethylene glenoid), Neer II (plastic glenoid surface with metal backing), Cofield, and Gristina monospherical total shoulder prostheses were tested for joint subluxation resistance and glenoid component fixation strength. Synthetic glenoid models with consistent structural properties and standard under-cutting geometry were used for glenoid component fixation with bone cement. It was found that joint subluxation resistance varied linearly with axial compressive force applied. Higher subluxation strength was associated with the amount of curvature of the glenoid articulating surface. Consequently, joint stability was consistently higher for the Gristina design, and all had lower resistance in the anteroposterior direction. After complete joint dislocation under high axial compressive force, the polyethylene material at the site of subluxation experienced gross plastic deformation. The fixation strength of the glenoid component was lowest for the Neer I design and highest for the Cofield design. Fatigue loading at the joint did not seem to affect the glenoid component fixation strength. In general, all glenoid components appeared to have sufficient fixation strength against normal shoulder joint forces except the Neer I design. Loosening and fracture of the plastic glenoid component may occur under excessive loads.

Biomechanical Phenomena↗
PubMed1988

Comminuted fractures of the proximal humerus.

Difficulty in fully defining the injury, patient characteristics, osteoporosis, technically difficult surgery, the need for carefully supervised physiotherapy, and the realization that a poor initial result is very difficult to reconstruct make the comminuted fracture of the proximal humerus a problem fracture. The literature on this fracture is also incomplete and confusing. The solutions are many and complex: use adequate roentgenograms to understand the traumatic lesion, be careful to avoid denying older patients effective surgical treatment, use a safe and simple surgical approach, know the options for internal fixation, recognize the values of prosthetic replacement, avoid technical pitfalls, and thoughtfully supervise the postoperative patient care.

Fracture Fixation, Internal↗
PubMed1988

Rupture of the tendon of the long head of the biceps brachii. Surgical versus nonsurgical treatment.

Twenty-seven shoulders (in 26 patients) that had surgical repair of a rupture of the long head of the biceps tendon between 1962 and 1981 were evaluated at three to 22 years after injury (mean, 13 years). Thirty similar patients had been treated nonsurgically and were evaluated two to 15 years (mean, 4.6 years) after tendon rupture. Biomechanical testing was performed on ten patients in the surgical group and 13 in the nonsurgical group. Residual arm pain was infrequent in both surgically and nonsurgically treated groups. Residual subjective weakness at the elbow was reported in four of the surgical group and in 20 of the nonsurgical group. Surgically treated patients returned to work later than nonsurgical patients; however, 11 in the nonsurgical group were not able to return to full work capacity, versus only two in the surgical group. On biomechanical testing, the nonsurgical group had lost a mean of 21% of supination strength and 8% of elbow flexion strength but had no weakness in grip, pronation, or elbow extension. The surgical group had lost no strength in any of these testing modes.

Adult↗
PubMed1987

Evaluation and classification of shoulder instability. With special reference to examination under anesthesia.

Increasing knowledge of instability in the shoulder has created a more complex evaluation sequence. The history continues to be important. Many physical examination maneuvers are available to further define the problem. Routine roentgenographic examination has been extended to include views specifically designed to demonstrate subtle bony changes. Complex radiographic contrast studies, especially computed arthrotomography, can confirm most anatomic lesions. When surgical treatment is under consideration, reexamination under anesthesia is increasingly being recognized as an important, essential procedure. Arthroscopy will effectively identify pathologic lesions within the joint and confirm uncertain diagnoses. An organized sequence of examinations is necessary for a thorough clinical investigation. After the investigation is complete, a classification of the shoulder instability can be made that relates to the results of treatment. The classification includes the elements of etiology, volition, direction of instability, and degree of instability.

Anesthesia↗
PubMed1987

Interscalene block anesthesia for shoulder surgery.

One hundred patients had major shoulder surgery with interscalene brachial and cervical plexus block anesthesia. Successful anesthesia was obtained by using this method in 82 patients. Failure was the result of incomplete anesthesia in 16 patients or the presence of a complication. Complications from high blood levels of anesthetic included loss of consciousness and respiratory depression in three patients and seizure in one. The block lasted a mean of eight hours, decreasing the need for postoperative analgesic medications. No postoperative medical complication developed. Ninety-one percent of the patients with successful blocks were satisfied with the procedure.

Adult↗
PubMed1986

Biomechanical study of the ligamentous system of the acromioclavicular joint.

The ligamentous structures of the acromioclavicular joint were studied by gross examination and quantitative measurement in twelve human cadaver specimens. Distances between insertions at various extreme positions of the clavicle were studied with the biplane radiographic technique. Ligamentous contributions to joint constraint under displacements were determined by performing load-displacement tests along with sequential sectioning of the ligaments. Twelve modes of joint displacement were examined. The acromioclavicular ligament acted as a primary constraint for posterior displacement of the clavicle and posterior axial rotation. The conoid ligament appeared to be more important than has been previously described. That ligament played a primary role in constraining anterior and superior rotation as well as anterior and superior displacement of the clavicle. The trapezoid ligament contributed less constraint to movement of the clavicle in both the horizontal and the vertical plane except when the clavicle moved in axial compression toward the acromion process. The various contributions of different ligaments to constraint changed not only with the direction of joint displacement but also with the amount of loading and displacement. For many directions of displacement, the acromioclavicular joint contributed a greater amount to constraint at smaller degrees of displacement, while the coracoclavicular ligaments, primarily the conoid ligament, contributed a greater amount of constraint with larger amounts of displacement.

Acromioclavicular Joint↗
PubMed1985

Anterior shoulder instability.

Techniques of reduction include direct pressure on the humeral head, leverage through the arm, and traction maneuvers. Reduction should be expeditious but gentle. The modified Stimson, abduction, and scapular manipulation methods are effective and safe--not requiring forceful pressure or leverage. Controversy continues about postreduction immobilization and rehabilitation. In younger persons (less than 30 years of age), especially athletes, the literature supports 3 to 6 weeks of immobilization followed by an extensive rehabilitation program and avoidance of sports for at least 2 to 3 months. Many factors enter into the selection of a repair method for recurrent anterior instability. They tend to favor a method that will allow identification of the pathologic condition and treatment of the Bankart lesion or capsular laxity, if present, without concomitant use of metallic internal fixation. One such repair technique is illustrated in a step-by-step sequence.

Adult↗