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Biomedical subjects

R W Eberle

Publications and source records attributed to R W Eberle.

12 recordsLinked to original sources
PubMed2000

Noncemented acetabular component removal in the presence of osteolysis: the affirmative.

The strategy for retention or removal of the acetabular component to address osteolytic activity is becoming an increasingly debated issue among joint replacement surgeons. It is paramount to the success of the revision surgery to eliminate the particulate debris source and thoroughly debride and graft the periacetabular regions. Visualization and complete access to all periacetabular regions require acetabular component removal. The authors present an opinion on acetabular component removal and introduce an impaction grafting method for addressing periacetabular osteolysis. The intermediate results at an average of 41 months are excellent with one patient requiring rerevision of the acetabular component at 83 months postoperative because of aseptic loosening. The outcome of revision total hip arthroplasty has been shown to be inferior to primary total hip arthroplasty, with each following revision having less probability for success equaling the preceding procedure. However, it is the authors' opinion that removing the entire acetabular component is the most prudent choice to eliminate and to avoid the introduction of adverse variables such as particulate debris and component malposition and nonconformity, which may contribute to the continuation of the osteolytic process.

Acetabulum↗
PubMed1999

Minimally invasive surgical technique for unicondylar knee arthroplasty.

Between August 1992 and December 1996, more than 700 unicondylar knee arthroplasty (UKA) procedures were done by the senior author (JA.R.), using well-defined patient selection criteria, which is paramount to the outcome of the procedure. The UKA procedure described is done through a smaller incision than that required for total knee arthroplasty (TKA) (3 inches versus 8 inches), thus minimizing blood loss (less than 200 mL), avoiding normal tissue sacrifice (opposite compartment, patellar bone, and cruciate ligaments), and decreasing morbidity (no patellofemoral disruption). The UKA costs less because it is done as an outpatient procedure in 80% of cases; since postoperative physical therapy is minimal or unnecessary, recovery time is shorter (90% independent function at 2 weeks after operation). Whereas TKA can have universal application, UKA is patient specific and cannot replace TKA in all circumstances. Likewise, the techniques for TKA and UKA are not interchangeable. However, with the use of well-defined patient populations and surgical techniques, the intermediate results of UKA have paralleled reported outcomes of TKA.

Arthroplasty, Replacement, Knee↗
PubMed1999

Dislocation after total hip arthroplasty using the anterolateral abductor split approach.

The three basic surgical approaches used most commonly in total hip arthroplasty are transtrochanteric, posterior, and anterolateral. Complications related to each of these surgical approaches have been reported including dislocation, trochanteric nonunion, heterotopic ossification, neurovascular damage, postoperative limp, and implant malalignment. The anterolateral abductor split approach previously has been reported to allow ease of access into the hip joint, optimum joint visualization, protection of neurovascular structures of the hip, and predictable results for postoperative hip function restoration. Reviewing a large consecutive series of primary total hip arthroplasty cases (1518), the authors report an overall dislocation rate less than 1% (12:1518; 0.79%). Stratified by preoperative diagnosis, patients undergoing total hip arthroplasty after trauma, or presenting with congenital dysplastic hip are at the highest risk for postoperative dislocation. Primary total hip arthroplasty using the anterolateral, abductor split approach can minimize the rate of postoperative dislocation in the prevailing preoperative diagnostic categories.

Adult↗
PubMed1997

False aneurysm of the common femoral artery after total hip arthroplasty. A case report.

A 59-year-old healthy man presented with osteoarthritis of his left hip that was recalcitrant to nonoperative treatment. He subsequently elected to have arthroplasty of the hip performed. At 3 months after arthroplasty, he returned reporting progressive groin pain: most remarkable was a palpable mass in the groin region. An arteriogram showed a radiodense mass adjacent to the acetabulum, and a computed tomography scan with contrast confirmed a large false aneurysm originating from the common femoral artery. In this particular case, a pointed Hohmann retractor punctured the common femoral artery, creating the dynamics of the development of a false aneurysm. Primary suture repair of the vascular defect was performed, followed by a complete and uncomplicated recovery of the patient to full activity. Since this case, the authors have discontinued the use of pointed. Hohmann retractors and now use a blunt, rounded Hohmann retractor during total hip arthroplasty without compromising acetabular exposure. However, care must be taken in blunt retractor placement to avoid retractor slippage during the procedure. This case shows the need for awareness of potential mechanisms for vascular injury related to total hip arthroplasty.

Aneurysm, False↗
PubMed1996

Clinical and radiographic outcome of a cementless, titanium, plasma spray-coated total hip arthroplasty femoral component. Justification for continuance of use.

Between 1984 and 1986, 177 nonconsecutive, primary total hip arthroplasties were performed in 150 patients using the Mallory-Head Porous femoral component (Biomet, Warsaw, IN) inserted without cement. Average time to follow-up evaluation for the entire population (including all early revisions) was 76 months (6.3 years). There were 10 revisions (6%) with an average time to revision of 50 months (4.2 years). Two revisions were for component undersizing; three revisions were for aseptic loosening; four revisions were for acetabular component failure and one revision was due to a femoral fracture secondary to trauma. At the most recent follow-up visit, the average Harris hip score for all hips increased from 41.5 before surgery to 86.8 (P < .001). Radiographic assessments yielded an average Engh fixation score of 20.7. The Kaplan-Meier survival estimate for the average time to follow-up evaluation was 0.98. Based on our patient selection criteria and excellent intermediate clinical and radiographic results, the initial design strategies of the Mallory-Head Porous femoral prosthesis have been confirmed.

Adolescent↗
PubMed1995

Age changes of spine density in posterior-anterior and lateral projections in normal women.

Bone mineral density (BMD) was measured in 353 healthy white women using dual-energy X-ray absorptiometry (DXA). Measurements were made of both the posterior-anterior (PA) and lateral spine, as well as the proximal femur (neck and Ward's triangle). From age 50 to 80 years, the BMD of the PA spine and femur neck BMD had an 18% diminution (0.6%/year), and BMD of the lateral spine showed about a 35-40% decline (1.4%/year). The Ward's triangle region of the femur was not quite as decreased (30% or 1.1%/year). The BMD decrease associated with aging did not differ as much among sites when expressed relative to the intrapopulation variation rather than as a percentage. The Z-score for PA spine and femur neck BMD (-1.1) was significantly different than that for lateral spine BMD (-1.6); Ward's triangle was intermediate (-1.3), i.e., the lateral spine still showed the highest sensitivity to aging. However, the ability to detect age changes in an individual subject can be increased only if the precision error for lateral spine BMD is not increased to a greater extent than the sensitivity.

Absorptiometry, Photon↗
PubMed1995

Intercondylar distal femoral fracture. An unreported complication of posterior-stabilized total knee arthroplasty.

In an attempt to study the incidence of intraoperative femoral intercondylar fractures, two large series of posterior-stabilized total knee arthroplasty (TKA) systems were reviewed. Eight hundred ninety-eight nonconsecutive primary posterior-stabilized TKAs were compared with a second nonconsecutive series of 532 posterior-stabilized TKAs. Unique to the secondary TKA system is an intercondylar sizing guide to aid in verification of the intercondylar resection size. In the initial series, 40 distal femoral intercondylar fractures were noted (rate = 1:22; nondisplaced, 35; displaced, 5). In the secondary series, one displaced distal femoral intercondylar fracture occurred (rate = 1;532). The difference in the rate of fracture between the two populations was statistically significant (P<.001). Intraoperative distal femoral intercondylar fracture represents a potential complication of TKA and can be avoided with careful resection technique and size verification. No change in the postoperative rehabilitation program is required, however, for those patients identified with nondisplaced and intraoperative-stabilized displaced distal femoral intercondylar fractures.

Aged↗
PubMed1995

Failure of intraoperatively customized non-porous femoral components inserted without cement in total hip arthroplasty.

Seventy-four primary total hip arthroplasties were performed in sixty-eight patients between August 1990 and September 1991. Clinical assessments were made with use of the Harris hip score and, specifically, the pain component of that score. The preoperative radiographs were digitally quantified for calculation of the so-called canal-to-calcar ratio and the so-called cortical index. The postoperative radiographs were evaluated for the percentage of the cross-sectional area of the femoral canal that was occupied by the prosthesis; subsidence of the prosthesis; and adaptive osseous changes, including hypertrophic cortical remodeling, osteolysis, formation of sclerotic radiolucent lines around the prosthesis, and formation of a pedestal at the tip of the prosthesis. The indication for the arthroplasty was osteoarthrosis in fifty hips (68 per cent), avascular necrosis in fourteen (19 per cent), congenital dysplasia in six (8 per cent), and another diagnosis in four (5 per cent). The average duration of follow-up was thirty-one months (range, eleven to forty-six months). The average Harris hip score (and standard deviation) was 75 +/- 16.8 points (range, 29 to 100 points), and the average score for the pain component was 37 +/- 7.5 points (range, 0 to 44 points). The average canal-to-calcar ratio of the hips was 0.44 (range, 0.32 to 0.74), and the average cortical index was 0.54 (range, 0.33 to 0.66). The average subsidence of the component was 0.6 centimeter (range, 0.0 to 2.3 centimeters). The average fill of the canal was 100 per cent proximally, 97 per cent at the middle of the stem, and 92 per cent distally as measured on the anteroposterior radiographs made immediately postoperatively and 100, 95, and 90 per cent, respectively, as measured on the lateral radiographs. A failure occurred in twenty-one hips (28 per cent) in twenty-one patients, with an average time to failure of 21 +/- 13 months (range, one to forty-four months). The Kaplan-Meier survival estimate (and standard error) for this population was 0.45 +/- 0.11 (confidence interval, 0.67 to 0.23) at forty-four months. The average subsidence of the components that failed was 0.7 centimeter (range, 0.1 to 2.3 centimeters). There was no significant relationship between failure of the component and the age or sex of the patient, the diagnosis, or the side of the operation. Postoperative severity of pain (p = 0.09) or subsidence (p = 0.08) alone did not reach significance for predicting outcome. The Harris hip score alone (p = 0.05), the Harris hip score in combination with subsidence of the femoral component (p = 0.01), and the pain component of the Harris hip score in combination with subsidence of the femoral component (p = 0.01) were all significant for predicting outcome. No other measured radiographic variable was predictive of failure. Despite optimization of the fit of the component within the femoral canal and the percentage of the cross-sectional area of the femoral canal occupied by the component, the clinical results indicated a high rate of failure. Thus, these criteria are not the only requisites for stabilization of these femoral components without cement. On the basis of these data, we have discontinued the use of these intraoperatively customized, non-porous, smooth femoral prosthesis.

Activities of Daily Living↗
PubMed1993

Dual-energy X-ray absorptiometry measurement of bone mineral density around porous-coated cementless femoral implants. Methods and preliminary results.

The measurement of bone mineral density in defined areas around metal implants has improved with the development of dual-energy X-ray absorptiometry. We used this technique to compare the bone mineral density adjacent to metal cementless femoral implants with that of identical regions of bone in normal proximal femora. We studied the anteroposterior views only of 72 femora which contained total hip implants and 34 non-operated femora. We compared the regional bone mineral density of bone adjacent to proximally porous-coated and distally porous-coated implants of one design, to measure the relative differences in the remodelling changes induced by different amounts of porous coating. We also measured differences in bone density with time and with variations in implant size (and therefore stiffness). The greatest decrease in bone mineral density (34.8%) occurred in the most proximal 1 cm of the medial femoral cortex around relatively stiff, extensively porous-coated implants. The next most severe decrease (20% to 25%) was in the next most proximal 6 cm of the medial femoral cortex. Small, progressive decreases in bone mineral density continued for five to seven years after implantation.

Absorptiometry, Photon↗
PubMed1990

High-dose intravenous naloxone for the treatment of acute ischemic stroke.

To evaluate the safety and possible efficacy of high-dose naloxone for the treatment of acute cerebral ischemia, 38 patients received a loading dose of 160 mg/m2 over 15 minutes followed by a 24-hour infusion at the rate of 80 mg/m2/hr. Nausea and/or vomiting were common side effects. Naloxone was discontinued in seven patients (because of hypotension in one, bradycardia and hypotension in two, myoclonus in one, focal seizures in two, and hypertension in one); all seven patients responded to treatment and no permanent sequelae to naloxone were noted. Twelve of the 38 patients showed early neurologic improvement (by completion of the naloxone loading dose). However, there was no correlation between such a loading dose response and clinical outcome at 3 months. Our experience suggests that naloxone is safe at the dose used, but data for efficacy are inconclusive.

Acute Disease↗