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Biomedical subjects

R S Bryan

Publications and source records attributed to R S Bryan.

At least 37 records · Page 2Linked to original sources
PubMed1984

Polycentric total knee arthroplasty. A ten-year follow-up study.

After review of the first 209 polycentric total knee arthroplasties (in 159 patients) performed at the Mayo Clinic between July 1970 and November 1971, we found that the calculated probability of the arthroplasty remaining successful ten years postoperatively was 66 per cent. Actual results showed 42 per cent of the arthroplasties to be successful in patients who were still alive at review; another 24 per cent were successful but were in patients who had died or were lost to follow-up before ten years postoperatively. In 34 per cent failure occurred, which we defined as reoperation for any reason, unacceptable pain, or loss of function. The most common causes of failure were instability or ligament laxity (13 per cent), loosening of a component (7 per cent), infection (3 per cent), and patellofemoral joint pain (4 per cent). Prior knee surgery significantly decreased the probability of success, as did axial malalignment of the prosthetic components at operation.

Adult↗
PubMed1983

Reimplantation for the salvage of an infected total knee arthroplasty.

We retrospectively reviewed the results in fourteen patients in whom salvage of an acutely infected total knee arthroplasty was attempted between 1970 and 1981 by the implantation of a new prosthesis within two weeks of removal of the infected one. Salvage was successful in six of the seven patients with a low-virulence infection but in only two of the seven patients with a high-virulence infection. Of the eight patients for whom the result was a functioning prosthesis, two had significant restriction of motion and one had moderate pain. If these three patients are eliminated from analysis, the over-all success rate is only 35 per cent (five of fourteen patients). We concluded that the implantation of another prosthesis for the treatment of infection of a total knee arthroplasty should be done with caution, and preferably when the infection has been caused by a low-grade organism and after a waiting period of longer than two weeks.

Adult↗
PubMed1983

Infection after total elbow arthroplasty.

Deep sepsis occurred after fourteen (9 per cent) of 156 elbow-replacement procedures in 140 patients. This high frequency of infection was attributed to several factors. First, the patients were drawn from a population that was at high risk of infection, because rheumatoid arthritis and post-traumatic arthritis were the indications for arthroplasty. Second, many of the patients had had prior surgery, which significantly (p less than 0.02) increased the risk of sepsis in those with rheumatoid arthritis. Third, some patients had surgery after the arthroplasty, which also seemed to predispose to deep infection (p less than 0.05). In one patient the elbow was salvaged by early débridement, and in two others reimplantation of a total joint replacement was successful after removal of the first prosthesis and control of the infection. Resection arthroplasty was required to arrest the infection in ten patients, eight of whom had a satisfactory result. The high incidence of this significant complication attests to the hazardous nature of the elbow-replacement procedure and should warn orthopaedic surgeons to be cautious when recommending this form of treatment.

Adult↗
PubMed1982

Condylar nonunions of the elbow.

Between 1968 and 1978, 32 patients were seen with nonunion of distal humerus fractures in close proximity to the elbow: 25 were treated with open reduction and fixation of the nonunion, and seven patients were treated with excision of the distal fragments and total elbow arthroplasty. Of the 25 patients treated with open reduction and fixation, 22 had union at an average of 7.74 months. However, six of these patients needed secondary procedures for repeat bone grafting or revision of the fixation device. Two of the seven patients with total elbow arthroplasty needed reoperation for loose humeral components.

Adult↗
PubMed1982

Revision after total knee arthroplasty.

Revision of a total knee arthroplasty is most frequently required because of prosthetic loosening, instability, and failure to restore proper axial alignment. The instability and improper axial alignment may result in abnormal stresses that predispose to component loosening, component failure, and stress fracture of the tibia. Therefore, it is essential to obtain correct axial alignment and soft tissue balance at the time of the initial arthroplasty. Approximately two thirds of those knees having one or more revisions of their arthroplasty will have a satisfactory result. One third will have an unsatisfactory result related to continued pain or restricted motion, or both. We have reported the results in 142 knees, 95 of which had one revision, 37 of which had two revisions, and 10 of which had three revisions. It is essential in such revisions, in our opinion, to thoroughly debride the knee, restore quadriceps balance, establish the correct alignment, minimize bone loss, and use the least possible constraint in the prosthesis combined with an external brace for three to six months.

Adult↗
PubMed1982

Extensive posterior exposure of the elbow. A triceps-sparing approach.

Difficulty with triceps avulsion or loss of continuity after total elbow arthroplasty has prompted the development of a modified posterior approach to the elbow joint. The characteristic feature of this approach is that the triceps mechanism is reflected from medial to lateral in continuity with the forearm fascia and the olecranon and ulnar periosteum. A variant of the technique reflects the extensor mechanism from lateral to medial. The ulnar collateral ligament may be released from the humerus to provide more exposure, but the ligament must then be securely reattached. This approach, which provides extensive exposure to the elbow joint, has been employed in 49 consecutive total elbow arthroplasties and results show no loss of triceps function and no significant weakness. The approach has proved useful for treatment of intra-articular fractures of the distal end of the humerus and with synovectomy in the rheumatoid arthritic patient.

Elbow Joint↗
PubMed1982

Revision total knee arthroplasty.

The most frequent reasons for revision of total knee arthroplasty are loosening, instability, and abnormal axial alignment. Failure to obtain appropriate component orientation, axial alignment, and soft tissue balance predisposes the implants to loosening and failure. The use of minimally constrained prostheses and careful attention to the technique are essential. Revision surgery may be successful in approximately two-thirds of the knees.

Adult↗
PubMed1982

Complications of total elbow arthroplasty.

The need for revision surgery for loosening exceeds 25% with tightly constrained prostheses but is much less with the semiconstrained designs. Resurfacing prostheses may be unstable if not adequately balanced by static and dynamic soft-tissue constraints. Infection is excessive (4%-9%), but resection arthroplasty is a reasonably good salvage procedure. Implant failure is rare. The ulnar nerve is subject to transient (10%) or, occasionally, partial dysfunction. Routine anterior translocation has been beneficial, but there is considerable variation in technique in this regard. Triceps insufficiency can be virtually eliminated with the Kocher lateral-to-medial or the Bryan lateral-to-medial triceps-sparing approach. Fractures of the ulna usually can be treated by cast application, but humeral fractures may require revision surgery because of component loosening. Some complications are decreasing in frequency, whereas others are becoming more widely appreciated. The procedure remains a challenging one, and is one that should be performed by those who are experienced in elbow surgery and who have a detailed knowledge of the numerous potential pitfalls.

Elbow Joint↗
PubMed1981

Chronic sprains of the carpometacarpal joints.

The relatively rigid second and third carpometacarpal joints provide stability for the cantilevered metacarpals of the index and middle fingers, about which the thumb and ulnar metacarpals move, providing spatial adaptation for grasping objects. Although seldom recognized, sprains of the carpometacarpal joints as part of a range of injury which includes subluxations, dislocations, and fractures are apparently common. The entity known as carpe bossu also may be related. The second and third carpometacarpal joints are more susceptible to injury in palmar flexion than in dorsiflexion. The sprain may be acute or chronic. Severe swelling over the carpometacarpal area, with tenderness and weakness without significant roentgenographic findings, is suggestive of the acute sprain, which generally responds to immobilization. The chronic sprain is often overlooked or misdiagnosed. Point tenderness of one or more carpometacarpal joints, a palpable laxity, and crepitus with manipulation are seen as physical findings, in decreasing order of frequency. Lidocaine, 0.5 ml, injected directly into the joint offers dramatic relief. If conservative measures are insufficient, arthrodesis of the joint is relatively simple, symptomatically reliable, and functionally uncompromising, especially of the second and third rays.

Adolescent↗
PubMed1981

Unicompartmental knee arthroplasty using polycentric and geometric hemicomponents.

Unicompartmental knee arthroplasty was performed in 207 knees of 179 patients using either a polycentric (188) or a geometric (nineteen) hemicomponent. After an average follow-up of 2.6 years, the results in 184 (89 per cent) of the knees were satisfactory. Pain and the need for ambulatory aids were reduced, and the distance the patients could walk was increased. Twenty-three (11 per cent) of the 207 procedures were rated as failures. The major cause of failure was loosening of the components (tibial in twelve and femoral in one); there also were unexplained pain in five knees, problems with the opposite unreplaced compartment in three, technical error in one, and pain in the patellofemoral joint in one. Nine of 155 intraoperative specimens for bacterial culture obtained during unicompartmental arthroplasty were positive, and two specimens that were positive on culture were obtained during revision of twenty failed unicompartmental arthroplasties. No gross or histological evidence of infection was demonstrated at operation. Based on this study, we concluded that this procedure can provide satisfactory relief of pain, adequate knee motion, and increased levels of independence and activity for patients with unicompartmental disease who are not suitable candidates for proximal tibial osteotomy or total knee replacement.

Adult↗
PubMed1981

Total elbow arthroplasty. A five-year experience at the Mayo Clinic.

During the five years from 1973 through 1977, eighty Mayo and Coonrad total elbow arthroplasties were performed in seventy-two patients at the Mayo Clinic. Follow-up after at least two years (average, four years) revealed that the results were good in 60 per cent, fair in 16 per cent, and poor in 24 per cent. Pain was a major symptom in 80 per cent of the elbows preoperatively but in only 3 per cent postoperatively. At follow-up, motion had increased: extension-flexion by 10 degrees (average range, 29 to 131 degrees of flexion) and forearm rotation by 26 degrees (average range, 61 degrees of pronation to 59 degrees of supination). Excluding eleven prostheses with loosening for which revision was necessary, there were forty-four complications (55 per cent) after eighty procedures. Of these forty-four complications, eleven were ulnar neuropathies (two permanent and nine transient); four were wound-healing problems; ten, significant triceps weakness; eleven, intraoperative fractures of the medial or lateral supracondylar bone column; seven, deep infections; and one was an ulnar fracture. Although the complication rate was very high, most of the complications occurred during the early years of the study. Follow-up revealed twenty-nine elbows with radiolucency around the components: in twenty-five about the humeral and in four about the ulnar component. Revisions were performed in nineteen (24 per cent) of the eighty elbows: in eleven because of loosening, in seven because of deep infection, and in one because of ankylosis. Intraoperative supracondylar fracture and defective cementing of the prosthesis were important factors contributing to prosthetic loosening. When the arthroplasty was successful, the relief of pain was dramatic, stability was excellent, and the range of motion was superior to that provided by any other procedure currently available.

Arthritis↗
PubMed1980

Fractures of the carpal bones other than lunate and navicular.

Injuries to the carpals and their ligaments are difficult to diagnose unless one utilizes special X-ray techniques based upon a careful history of the injury and examination for tender points and painful joints. Use of only standard X-rays and cursory examinations caused many injuries to be missed in earlier years. Many fractures resolve with simple splinting or casting, but many do not, and late sequelae are now being diagnosed more commonly than in the past. Localization of pathologic conditions by diagnostic injections of local anesthesia or arthrography (or both) is very helpful. Salvage may require excision of fragments, exostoses, reconstruction of ligaments, or local arthrodesis.

Adult↗
PubMed1979

Mechanical cornpicker hand injuries.

The mechanical cornpicker causes tearing anse injuries from 1962 to 1975 were studied with regard to mechanism and extent ohe time of injury in 36% of hands, and in 73% of the remainder following treatmophylaxis, and antibiotics, and 73% hands required some form of delayed surgical treatment. Antibiotics did not appear to be helpful. Eighty-nine ps the most common cause given for farmers for their injuries. Excluding four pr permanently disabled patients, the average length of disability was 135 days. Eighty-nine per cent of patients experienced some permanent impairment of hand function. The mechanical cornpicker is described, and the importance of its proper use and physician's emphasis on accident prevention as well as treatment are stressed.

Adolescent↗
PubMed1979

Arthrodesis of the knee following failed total knee arthroplasty.

In forty-five patients, who had an arthrodesis because of failed total knee arthroplasty, the cause was infection in forty, instability in two, failure of the prosthesis in two, and loosening in one. The arthrodesis succeeded in twenty-nine (81%) of thirty-six patients who had had a minimally or partially constrained arthroplasty and in five (56%) of nine who had had a hinge-type prosthesis inserted. The reasons for failure were severe bone loss, persistent sepsis, and loss of bone apposition after manipulation. The technique of arthrodesis did not seem to influence the final result. External fixation most commonly had to be used because of the infections and the device was kept in place for an average of ten weeks, after which immobilization in a cast was used until the arthrodesis healed.

Adult↗
PubMed1979

Total joint arthroplasty. The elbow.

The first total elbow arthroplasty at the Mayo Clinic was performed in 1972, and it provided markedly superior results compared with previously performed procedures for elbow arthritis. However, a high revision rate (14%), due mainly to loosening (75%), tempered early enthusiasm for the procedure. Prospects for improved design and surgical technique based on our clinical experience and biomechanical data are encouraging. For the present, however, more limited procedures are recommended, and the total elbow arthroplasty is reserved for only a relatively few patients for whom there are no other viable surgical options.

Arthritis↗
PubMed1978

Osteochondritis dissecans of the knee with loose fragments. Treatment by replacement and fixation with readily removed pins.

We reviewed six patients with a five to fifteen-year follow-up and a seventh with shorter follow-up who underwent replacement and fixation with easily removable pins of large osteocartilaginous fragments resulting from osteochondritis dissecans. Excellent or good results were achieved in all but one patient. Preparation of the fragments to fit into their vascularized beds prior to internal fixation is advisable, and in some cases the bed should be partially filled with cancellous bone before the fragments are replaced. Immobilization is prescribed until the pins are removed three to six weeks after surgery. Weightbearing is delayed until there is roentgenographic evidence of beginning union of the fragment to the underlying bone.

Adolescent↗