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Biomedical subjects

Richard H Rothman

Publications and source records attributed to Richard H Rothman.

At least 19 recordsLinked to original sources
PubMed2007

Clinical experience using a minimally invasive surgical approach for total knee arthroplasty: early results of a prospective randomized study compared to a standard approach.

There has been recent attention concerning minimally invasive techniques for knee arthroplasty. It is not clear whether these complicated techniques can be reproduced across multiple centers and for all surgeons. This prospective, randomized, multicenter study was carried out to assess safety and efficacy of a minimally invasive total knee arthroplasty. The study consisted of 80 knees. There were no differences in blood loss, operative time for completion of surgery, infection, and ultimate wound healing. There were 4 knees with delayed wound healing in the minimally invasive surgical technique group versus 1 in the standard group, which did not affect outcome. Early clinical and radiographic results were also indistinguishable. At 12 weeks follow-up, there was no difference in mean Knee Society objective and functional scores. In summary, in this study, minimal incision total knee arthroplasty demonstrated no improvement over a standard approach.

Aged↗
PubMed2007

Total joint arthroplasty: When do fatal or near-fatal complications occur?

BACKGROUND: With the recent trend toward minimally invasive total joint arthroplasty and the increased emphasis on faster recovery and shorter hospital stays, it has become increasingly important to recognize the timing and severity of the various complications associated with elective total joint arthroplasty to ensure that early patient discharge is a safe practice. METHODS: We evaluated the systemic and local complications associated with primary unilateral lower-extremity arthroplasties performed during one year in 1636 patients. A total of 966 patients had a primary total hip arthroplasty, and 670 had a primary total knee arthroplasty. All complications that occurred in the hospital and for six weeks following the index surgery were recorded. The circumstances leading to the complications and the details of the therapeutic intervention for each complication were recorded. Analyses were performed to predict the factors that predispose patients to serious complications. RESULTS: One patient (0.06%) in the cohort died during the hospital stay. There were a total of 104 major (life-threatening) complications, including cardiac arrest (one), tachyarrhythmia (thirty-three), pulmonary edema or congestive heart failure (ten), myocardial infarction (six), hypotensive crisis (four), pulmonary embolus (twenty-five), acute renal failure (fourteen), stroke (six), bowel obstruction or perforation (three), and pneumothorax (one). There were seventeen major local complications. Ninety-four (90%) of the major complications occurred within four days after the index surgery. Although older age, increased body mass, and preexistent comorbidities were important predisposing factors for serious medical complications, 58% of the patients who had life-threatening complications develop had no identifiable predisposing factors. CONCLUSIONS: This study demonstrated that most of the complications of lower-extremity total joint replacement occur within the time-frame of the typical hospital stay. Given the serious nature of some of these complications and the inability to identify many of the patients who may be at risk, we caution against early discharge of patients from the hospital after elective total joint arthroplasty in the lower extremity.

Adolescent↗
PubMed2006

Total hip arthroplasty: is small incision better?

Outcome data are eagerly awaited at present time to evaluate the role of minimally invasive surgery in orthopedic surgery. This matched-pair study reports the outcome of total hip arthroplasty (THA) performed through regular or small incision technique by a single surgeon. There were 120 patients in this cohort with a mean age of 66.8 years (range, 39-90 years). There was no detectable difference in outcome between the two groups with regard to blood loss, analgesia requirement, functional recovery, length of hospital stay, or disposition at discharge. One patient in the small incision group with undersized femoral component required revision of the femoral stem 8 months later. The recent extensive interest for minimally invasive THA has been attributed to market-driven and patient-driven demand for this procedure. We were not able to detect any difference in outcome parameters for THA performed through small incision compared with the conventional techniques.

Acetabulum↗
PubMed2006

Total hip arthroplasty for acute femoral neck fractures using a cementless tapered femoral stem.

The purpose of this study was to evaluate the osseointegration potential and implant-related complications of cementless total hip arthroplasty with a titanium alloy collarless, tapered, wedge-shaped femoral stem with a proximal circumferential plasma-spray coating in patients with acute hip fractures. The cohort consists of 85 patients with a mean age of 78.1 years. The mean duration of follow-up was 3.8 years. Total hip arthroplasty conferred significant improvement in function for all patients. All femoral components were stable with evidence of bone ingrowth (84 hips) or fibrous fixation (1 hip). Mild thigh pain was present in 3 patients. The complications included dislocation (3 cases), intraoperative femoral fracture (2 cases), and periprosthetic femoral fracture in the postoperative period (1 case). There was one reoperation for revision of the femoral component in the patient with a periprosthetic fracture. There were 25 (29%) deaths. Cementless total hip arthroplasty using a tapered proximally coated femoral stem is a viable option for the treatment of a displaced hip fracture and preexistent arthritis.

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PubMed2006

Ninety-day mortality after bilateral hip arthroplasty.

Despite lack of any studies, to our knowledge, bilateral total hip arthroplasty (THA) is believed to carry higher perioperative mortality. The purpose of this study is to investigate the incidence of mortality within 90 days of bilateral THA in a major urban medical center. The incidence of 90-day mortality after 1-stage bilateral THA performed in 707 patients between 1995 and 2004 was evaluated. A detailed analysis of our database was performed to determine which bilateral THA patients died within 90 days of surgery. Every living patient who had undergone bilateral hip arthroplasty was contacted. One patient (0.14%, 1/707) died within 90 days of 1-stage bilateral THA. The patient developed spontaneous retroperitoneal hematoma requiring massive transfusion. The patient died of multisystem failure 35 days after undergoing bilateral THA. One-stage bilateral uncemented THA performed in a select group of healthy and young patients carries an acceptable risk.

Adolescent↗
PubMed2006

One-stage bilateral total hip arthroplasty compared with unilateral total hip arthroplasty: a prospective study.

It is believed that patients undergoing 1-stage bilateral joint arthroplasty are at higher risk for developing cardiopulmonary and possibly other complications. The aim of this prospective matched study was to evaluate and compare the morbidity profile of patients undergoing 1-stage bilateral uncemented total hip arthroplasty (BTHA) vs unilateral uncemented THA (UTHA). One hundred consecutive patients undergoing 1-stage bilateral THA (50 patients, 100 hips) and unilateral THA (50 patients) were recruited and prospectively followed. There were no statistically significant differences in 90-day mortality, individual major (BTHA, 8%; UTHA, 10%) or minor (BTHA, 20%; UTHA, 26%) complications between the 2 groups. Bilateral THA patients required more autologous and allogenic blood transfusion and had lower hemoglobin at discharge than UTHA patients. Patients undergoing BTHA should expect a slightly higher incidence of complications related to postoperative anemia.

Adolescent↗
PubMed2006

Hip arthroplasty with minimally invasive surgery: a survey comparing the opinion of highly qualified experts vs patients.

In recent years, there has been an increasing debate regarding the possible role of minimally invasive (MIS) total hip arthroplasty (THA). We conducted a questionnaire survey of the Hip Society members and compared the responses of the surgeons with those of patients who were being considered for THA. 80% of surgeons who completed the survey admitted to performing MIS THA, of whom two thirds defined MIS as small incision. Of surgeons, 74% had encountered some complication related to MIS THA; 67% of patients had not heard of MIS THA. The knowledge regarding MIS THA expressed by 80% of patients was either inaccurate or not substantiated by any studies. This survey highlights the inadequacy of our current understanding of MIS THA and lack of education on the part of the patients.

Arthroplasty, Replacement, Hip↗
PubMed2006

Ninety-day mortality after hip arthroplasty: a comparison between unilateral and simultaneous bilateral procedures.

This study compares the 90-day mortality of unilateral total hip arthroplasty (THA) with simultaneous bilateral THA. Patient demographics, cause of death, and risk factors for mortality after THA were investigated. A total of 6258 patients (6791 hips) received primary THA using uncemented prostheses from 1995 to 2002. There were 5725 (91%) patients who received unilateral THA, whereas 533 (9%) patients underwent simultaneous bilateral THA. Of 6258 patients, 10 (0.16%) died within 90 days of THA, none of whom underwent simultaneous bilateral THA (0%, 0/533). Simultaneous bilateral uncemented THA performed in a select group of patients carries no greater perioperative mortality rate than unilateral THA.

Adolescent↗
PubMed2005

Minimally invasive total hip arthroplasty: internet claims made by members of the Hip Society.

We searched the Internet for Web sites related to 106 members of the Hip Society. Web sites (private and/or hospital affiliated) for each surgeon were evaluated for the term "minimally invasive total hip replacement" and its related names. One hundred two of the 106 Hip Society members (96%) had Web sites. Of the 102 Web sites, eight Web sites had links to multiple members of the Hip Society, resulting in 94 distinct sites. Nineteen percent (19 of 102 members) of Hip Society members made reference to minimally invasive hip surgery. 11% (10 of 94 sites) of Web sites included references to minimally invasive hip surgery. When the terms fast or quicker recovery were evaluated, 14% (14 of 102 members) of surgeons used these terms. There were references to these terms on 6% (six of 94 sites) of the members' Web sites. Two incision techniques were discussed by only 10% (10 of 102 members) of members, and reported on 4% (four of 94 sites) of Web sites. In contrast, only 26% (five of 19 members) of Hip Society members and 30% (three of 10 sites) of Web sites reported the risks. Although minimally invasive hip arthroplasty frequently is discussed and advertised by some surgeons, only a small percentage of Hip Society members actually promote or make claims to these techniques on their Web sites.

Arthroplasty, Replacement, Hip↗
PubMed2005

The role of patient restrictions in reducing the prevalence of early dislocation following total hip arthroplasty. A randomized, prospective study.

BACKGROUND: It is currently unknown whether functional restrictions following total hip arthroplasty can reduce the prevalence of early postoperative dislocation. Our hypothesis was that dislocation was more likely to occur in patients who were not placed on these restrictions. METHODS: We performed a prospective, randomized study to evaluate the role of postoperative functional restrictions on the prevalence of dislocation following uncemented total hip arthroplasty through an anterolateral approach. Of the 630 eligible consecutive patients, 265 patients (303 hips) consented to be randomized into one of two groups (the "restricted" group or the "unrestricted" group). The patients in both groups were asked to limit the range of motion of the hip to <90 degrees of flexion and 45 degrees of external and internal rotation and to avoid adduction for the first six weeks after the procedure. The patients in the restricted group were instructed to comply with additional hip precautions during the first six weeks postoperatively. Specifically, these patients were managed with the placement of an abduction pillow in the operating room before bed transfer and used pillows to maintain abduction while in bed; used elevated toilet seats and elevated chairs in the hospital, in the rehabilitation facility, and at home; and were prevented from sleeping on the side, from driving, and from being a passenger in an automobile. All patients were followed for a minimum of six months postoperatively. RESULTS: There was one dislocation in the entire cohort (prevalence, 0.33%). This dislocation occurred in a patient in the restricted group during transfer from the operating table to a bed with an abduction pillow in place. Patients in the unrestricted group were found to return to side-sleeping sooner (p < 0.001), to ride in automobiles more often (p < 0.026), to drive automobiles more often (p < 0.001), to return to work sooner (p < 0.001), and to have a higher level of satisfaction with the pace of their recovery (p < 0.001) than those in the restricted group. There was an additional expenditure of approximately $655 per patient in the restricted group. CONCLUSIONS: Total hip arthroplasty through an anterolateral approach is likely to be associated with a low dislocation rate. Removal of several restrictions did not increase the prevalence of dislocation following primary hip arthroplasty at our institution. However, it did promote substantially lower costs and was associated with a higher level of patient satisfaction as patients achieved a faster return to daily functions in the early postoperative period.

Adolescent↗
PubMed2004

Primary total hip arthroplasty with an uncemented femoral component: a long-term study of the Taperloc stem.

The purpose of the current study was to evaluate the long-term result of a tapered, uncemented femoral component. We retrospectively reviewed the clinical and radiographic records of 121 patients (129 hips) who underwent primary total hip arthroplasty with the use of the Taperloc uncemented stem. Follow-up averaged 11 years (range, 6-15 years). The mean Harris Hip Score at the latest follow-up was 92.1. Thigh pain was reported in 5 patients (3.6%). One stem was revised at 6 years because of severe proximal femoral osteolysis. There was no evidence of radiographic subsidence or loosening around any stems. The overall medium- to long-term outcome of the Taperloc stem is excellent, with a low revision rate and high patient satisfaction.

Adult↗
PubMed2004

Results of revision total knee arthroplasty after exposure of the knee with extensor mechanism tenolysis.

The purpose of this research was to investigate the utility of 1 surgical exposure method, extensor mechanism tenolysis (EMT), for total knee revision, and to evaluate complications associated with this technique. Two hundred seven knee revisions were performed on 198 patients (9 bilateral) over a 3-year period (September 1997 to October 2000). The surgical exposures used were EMT in 203 cases, V-Y quadricepsplasty in 2 knees, and patellectomy in 2 additional cases. The complications associated with EMT were peripatellar fibrosis requiring arthroscopy, 7.2%; hematoma, 4.8%; stiffness requiring manipulation, 3.9%; patellar subluxation, 1.4%; extensor lag >5 degrees, 1.0%; quadriceps tendon rupture, 0.5%; and instability, 0.5%. EMT is associated with a low complication rate comparable with or better than other exposure methods.

Adult↗
PubMed2004

Late sciatic nerve palsy caused by hematoma after primary total hip arthroplasty.

A case of late sciatic nerve palsy caused by subfascial hematoma after uncemented right total hip arthroplasty is reported. The patient developed respiratory distress 13 days postoperatively and was admitted to another institution, where she was diagnosed with pulmonary embolism and was subsequently therapeutically anticoagulated with heparin. The patient complained of right-leg numbness and tingling 18 days' postoperatively, which progressed to complete sciatic nerve palsy over several hours.

Aged↗
PubMed2004

Relationship between surgical volume and early outcomes of total hip arthroplasty: do results continue to get better?

This retrospective study explored the relationship between the volume of total hip arthroplasties (THA) and postoperative mortality and early complications from a single institution. One thousand hip arthroplasties in 932 patients were identified during a 1-year period, which included 786 primary and 214 revision hip arthroplasties. The postoperative 6-month combined medical and orthopedic complication rate for primary and revision THA was 7.9% and 16.5%, respectively. The 6-month mortality rate for the overall group was 0.5% (5 deaths), for the primary hips was 0.4% (3 deaths), and for the revision hip was 0.9% (2 deaths). The mortality and complication rates of many surgical procedures, including joint arthroplasties, are inversely related to hospital and surgical volume. The reduction in complication rate, however, approaches a plateau and does not improve regardless of an increase in the surgical and hospital volume.

Adult↗
PubMed2004

Frank Stinchfield Award. Titanium surface with biologic activity against infection.

Despite immense improvements, periprosthetic infection continues to compromise the result of otherwise successful joint arthroplasty. There are various limitations in the treatment of periprosthetic infection, the most important of which is the inability to deliver antibiotics to the local tissue without the need for intravenous administration. We have developed a novel route to covalently tether vancomycin to a metal (titanium) surface, which showed effective bactericidal activity because of a vancomycin coupling. The chemistry of tethering does not affect the biological activity of the biofactors that are attached to the metal surface. This technology holds great promise for the manufacturing of "smart" implants that can be self protective against periprosthetic infection, or can be used for the treatment of periprosthetic infections when they occur.

Awards and Prizes↗
PubMed2004

Prospective matched-pair analysis of hydroxyapatite-coated and uncoated femoral stems in total hip arthroplasty. A concise follow-up of a previous report.

This prospective study was performed to examine the results of total hip arthroplasty with a tapered uncemented femoral component with and without hydroxyapatite coating in a matched-pair group of patients. Since our original publication in 1996, no femoral component was revised in either group. After a mean clinical and radiographic follow-up of 9.8 years, all femoral components were stable, with no evidence of progressive radiolucency or osteolysis. Ten acetabular components were revised because of aseptic loosening and wear. Our study demonstrated no clinical or radiographic advantage, during the first decade after implantation, to the use of hydroxyapatite on this design of femoral component in primary total hip arthroplasty.

Aged↗