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Biomedical subjects

R M Barden

Publications and source records attributed to R M Barden.

7 recordsLinked to original sources
PubMed1996

Results of different surgical procedures on total knee arthroplasty infections.

Seventy-six consecutive infected total knee arthroplasties in 74 patients were treated between December 1981 and March 1990. The average follow-up period was 57 months (range, 24-121 months). No patients were lost to follow-up evaluation and 12 patients died from unrelated causes. Patients were classified, based on the duration of their symptoms prior to treatment, as acutely infected (< 2 weeks) or chronically infected (> 2 weeks). All knees were evaluated following surgical treatment with radiographs and Knee Society knee score assessment. Successful eradication of infection was defined as a knee without clinical evidence of infection for a minimum of 2 years. The initial treatment modality was successful in eliminating the infection in 69 of 76 patients (90%). Infection was eventually eradicated in 72 of 76 (94%) patients. The individual clinical result was found to be more dependent on a patient's medical and musculoskeletal status (patient class A, B, C) than on knee score or radiographic assessment. Careful treatment selection based on patient class and duration of infection can result in a predictable and successful result.

Acute Disease↗
PubMed1996

The prosthesis-bone interface adjacent to tibial components inserted without cement. Clinical and radiographic follow-up at nine to twelve years.

We evaluated the radiographic and functional status of a one-piece composite tibial component, designed to be inserted without cement, that was developed and used only at our institution. Thirty-six patients (thirty-seven knees) were managed with the component between November 1981 and September 1983, and none were lost to follow-up. When they were last seen, thirty-four (92 per cent) of the thirty-seven knees had a well-fixed tibial component, both clinically and radiographically. Eight patients (eight knees; 22 per cent) died. Eleven patients (eleven knees; 30 per cent) had a revision at an average of sixty-five months (range, four to ninety-five months) postoperatively. The reason for the revision was failure of a metal-backed patellar component in three knees, excessive wear of the polyethylene of the tibial component in one, a hematogenous infection in four, aseptic loosening of the tibial component in two, and chronic synovitis in one. The remaining seventeen patients (eighteen knees; 49 per cent) were seen for clinical and radiographic follow-up at an average of eleven years (range, nine to twelve years) after the operation. With removal of the implant as the end point, the cumulative rate of survival was 83 per cent at fifty-six months and 67 per cent at 108 months. Some of the failures were secondary to features of the prosthetic design that currently are considered to be inadequate, including a metal-backed patellar component and carbon-fiber-reinforced polyethylene. In the twenty-six knees in which the prosthesis had been retained, the implant was stable and the prosthesis-bone interface was unchanged as seen radiographically at the time of the most recent follow-up examination. This finding demonstrates that a porous ingrowth surface is capable of providing a secure interface for biological fixation over the long term.

Adult↗
PubMed1995

Miller-Galante unicompartmental knee arthroplasty at 2- to 5-year follow-up evaluations.

A consecutive series of 62 Miller-Galante (Zimmer, Warsaw, IN) unicompartmental knee arthroplasties were evaluated. Patients had unicompartmental degenerative arthritis or osteonecrosis, a sagittal plane deformity of 15 degrees or less, and minimal patellofemoral involvement. The average age was 69, with osteoarthritis in 85% and osteonecrosis in 15%. Ninety-five percent were medial and 5% lateral compartment replacements. The Hospital for Special Surgery knee score averaged 56 +/- 11 before surgery and 96 +/- 5 at the final follow-up evaluation, with an average postoperative pain score of 48 +/- 2. Three patients suffered intra-operative or immediate postoperative tibial plateau fractures without apparent sequelae, one patient required a postoperative manipulation under anesthesia, and one patient required an arthroscopic debridement for retained cement in the posterior capsular space. Limb alignment was corrected to within 5 degrees of the neutral mechanical axis in 77%, with 19% undercorrected and 3% overcorrected. Seventy percent of knees showed at least a single radiolucent line. Complete radiolucent lines were noted about three tibial components (6%) and progressive partial radiolucency was noted about four additional components (8%).

Aged↗
PubMed1991

Bone stimulators for fusions and fractures.

Even though a complete understanding of electrical responses of bone has not been fully obtained, useful data toward this end have been gathered. The development of devices that use what is known about the bone's electrophysiologic properties has impacted patient care. Many health care professionals remain skeptical about the effects of electrical stimulation in bone healing. Therefore, further research is needed to help the practitioner formulate a more educated opinion on this form of therapy.

Electric Stimulation Therapy↗
PubMed1990

Cemented and ingrowth fixation of the Miller-Galante prosthesis. Clinical and roentgenographic comparison after three- to six-year follow-up studies.

One hundred thirty-nine cemented and 132 cementless Miller-Galante total knee prostheses were followed between three and six years (average, 43-44 months). The fixation technique was based on patient age, bone quality, and ability to delay full-weight bearing. Clinical follow-up studies were possible on 116 cemented knees. Fifteen knees were lost because of death before the three-year follow-up study, and eight knees required component removal. One hundred twenty-three cementless knees were available for clinical follow-up studies; there were three deaths, and six failures required component removal. No cemented failure was due to fixation, and three cementless failures were due to lack of tibial ingrowth in two and pain of undetermined etiology in one. Preoperative knee scores were slightly significant with cemented knees averaging 48 points and cementless knees averaging 52 points. A similar significant difference was maintained at the final follow-up study. No significant differences were noted for pain, limp, or support scores. Average range of motion was similar in the two groups. Radiolucent lines about the femoral component were rare. Cementless tibial radiolucencies were partial in up to 20% of examined zones, and complete tibial tray radiolucency was seen in only three patients. No correlation between radiolucency and knee scores was seen.

Adult↗