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Robert E Booth

Publications and source records attributed to Robert E Booth.

36 records · Page 2Linked to original sources
PubMed2004

Outcomes of total hip arthroplasty are similar for patients with displaced femoral neck fractures and osteoarthritis.

This study attempted to evaluate whether total hip arthroplasty for displaced femoral neck fractures had significantly different outcomes when compared with total hip arthroplasty for osteoarthritis. This is a retrospective study of 60 patients who had total hip arthroplasties between 1997 and 2001. Thirty patients (mean age, 79.7 years) had total hip arthroplasties for displaced femoral neck fractures; 30 patients (mean age, 76.9 years) were treated with total hip arthroplasties for osteoarthritis. The same surgeon used the modified lateral approach for all surgeries. All patients had radiographic assessment, physical examination, and evaluation with the Harris hip score. The mean followup was 38 months. The mean Harris hip score for the 25 patients treated with a total hip arthroplasty for a femoral neck fracture was 81 points; the mean hip score for the 27 patients treated with a total hip arthroplasty for osteoarthritis was 87 points. No statistically significant differences between these groups were observed. Patients who were treated with a total hip arthroplasty for a femoral neck fracture did not have increased perioperative morbidity compared with patients who had a total hip arthroplasty for osteoarthritis. This study suggests that the outcomes for total hip arthroplasties in this consecutive series of patients treated for displaced femoral neck fractures and osteoarthritis are comparable.

Aged↗
PubMed2003

HIV risk behaviors among older American drug users.

Despite increasing numbers of Americans older than 50 years of age, little is known about the impact of HIV/AIDS on aging drug users. The current study assesses the drug-related and sex-related HIV risk behaviors of older and younger injection drug users and crack smokers. Structured interview responses from 1508 out-of-treatment active drug users older than 50 years of age were compared with those of 1515 out-of-treatment active drug users who were 50 years old or younger. Comparisons were also made within the older cohort to examine differences in risk behaviors between crack smokers and nonsmokers, men and women, and users older than 60 years of age and those in their 50s. Results indicated that although older drug users (older than 50 years of age) were less likely to have had sex in the prior month, those who did were as risky as their younger counterparts with regard to sex-related risk behaviors. They were, however, significantly less risky in their needle sharing practices than those 50 years old or younger. Among the older cohort, those who smoked crack were extremely risky. Men older than 50 years of age were riskier than women older than 50 years of age; however, users older than 60 years of age were no less risky than those in their 50s. Interventions designed for older drug users should focus on sex risk behaviors, especially among those who smoke crack.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Improving entry to methadone maintenance among out-of-treatment injection drug users.

This study of 577 out-of-treatment drug injectors was designed to assess predictors of methadone maintenance treatment entry, including offering free treatment coupons. Using targeted sampling methods, participants were recruited through street outreach; randomly, they were either assigned a coupon for 90 days of free treatment or required to pay for their treatment. Regardless of assignment, all subjects who desired treatment were provided transportation, rapid intake, and a waiver of the treatment entry fee. Overall, 33% entered treatment, including 66% of those who received a free coupon. Other factors associated with treatment entry included desire for treatment, heroin use, prior treatment experience, associating with fewer drug-using friends, and injecting with a previously used unsterile needle/syringe. Injecting cocaine and smoking crack reduced the probability of treatment entry. Findings lend support to street outreach efforts designed to increase rates of treatment entry among chronic out-of-treatment drug injectors. Additional treatment options are required for those abusing cocaine.

Adult↗
PubMed2003

Acute arterial complications associated with total hip and knee arthroplasty.

OBJECTIVE: To our knowledge, ours is the largest single-center experience with diagnosis and management of acute arterial hemorrhagic and limb-threatening ischemic complications associated with total hip arthroplasty (THA) and total knee arthroplasty (TKA). METHODS: Between 1989 and 2002, 23,199 TKA procedures (13,618 total, 11,953 primary, 1665 revision) and THR procedures (9581 total, 7812 primary, 1769 revision) were performed at the orthopedic service of Pennsylvania Hospital, Philadelphia. Arterial injuries were grouped according to type (ischemia, bleeding, pseudoaneurysm, ischemia plus bleeding) and time of recognition of injury (0-5 days after orthoplasty). RESULTS: Acute arterial complications developed in 32 patients (0.13%), associated with 24 TKA procedures (0.17%) and 8 THA procedures (0.08%; P =.0609). There were no deaths, and limb salvage was achieved in all patients. Arterial injury was detected by the orthopedic service on the same day (SD group) as performance of joint replacement in 18 patients (56%), but was not recognized until the first to fifth postoperative day (PO group) in 14 patients (44%). Arterial complications included acute lower-limb ischemia only in 18 patients SD group, 9; PO group, 9), bleeding only in 4 patients (SD group), arterial transection resulting in both ischemia and bleeding in 5 patients (SD group), and arterial pseudoaneurysm in 5 patients (PO group). Of the 18 patients with acute ischemia only, preoperative arteriography was performed in 12 patients (67%), and 6 patients (33%) were brought directly to the operating room because of advanced ischemia. Revascularization procedures in these 18 patients included bypass to the infrapopliteal artery (n = 7), popliteal artery (n = 5), or common femoral artery (n = 1); in only 5 patients (28%) was thrombectomy alone successful. These 18 patients tended to require fasciotomy (4 of 9 vs 2 of 9; P =.6199) and have foot drop (3 of 9 vs 1 of 9; P =.5765) more frequently when ischemia was recognized after the day of surgery. Bleeding was managed with arteriorrhaphy. Arterial transection was treated with end-to-end anastomosis (n = 3), interposition grafting (n = 1), and below-knee popliteal bypass (n = 1). Popliteal artery pseudoaneurysm was treated with percutaneous methods (n = 3) or surgery (n = 2). CONCLUSION: In this series, risk for arterial injury associated with THA and TKA was remarkably low. Nonetheless, even at a high-volume orthopedic hospital, acute arterial injury was not recognized on the day of surgery in about half of patients. Judicious use of preoperative arteriography and aggressive revascularization are critical to achieving limb salvage. Simple arterial thrombectomy to treat ischemic complications of THA and TKA is rarely sufficient.

Acute Disease↗
PubMed2003

Limited success with open debridement and retention of components in the treatment of acute Staphylococcus aureus infections after total knee arthroplasty.

The purpose of this study was to review our experience in treating acute gram-positive infections after total knee arthroplasty with debridement, component retention, and intravenous antibiotics. Thirty-one total knee arthroplasties with acute gram-positive infections, seen at our institution over a 10-year period, were treated with open debridement and component retention. Eleven (35%) of 31 patients successfully retained their components at most recent follow-up, without ongoing infection (mean, 4 years; range, 2-10 years). Only one (8%) of the 13 patients infected with Staphylococcus aureus was successfully treated, compared with 10 (56%) of 18 patients with either Staphylococcus epidermidis or a streptococcal species. The difference between these groups is statistically significant (P=.007). The high failure rate of debridement and component retention suggests that immediate component removal should be considered in the presence of acute S. aureus infection in total knee arthroplasty.

Acute Disease↗
PubMed2003

A two-stage approach to primary knee arthroplasty in the infected arthritic knee.

Fourteen patients with either septic knee arthritis or osteomyelitis of the knee with marked joint destruction were treated by resection arthroplasty with the introduction of an antibiotic cement spacer block, appropriate antibiotic therapy, and subsequent primary total knee arthroplasty. Most patients with septic arthritis had chronic infection. Eight patients had positive cultures preoperatively; the remaining patients had either a culture negative purulent aspiration or diagnostic radiographic studies. All patients underwent reconstruction with primary total knee arthroplasty on an average of 3.1 months after the initial stage procedure. Knee Society scores progressed from 46 preoperatively to 89 postoperatively, with an average range of motion from 3 degrees to 105 degrees. At latest clinical follow-up (average, 4.5 years), no patients had recurrence of infection. These data suggest that this method is successful in treating chronically infected knees with a 2-staged arthroplasty.

Aged↗
PubMed2003

Open debridement of acute gram-positive infections after total knee arthroplasty.

Open debridement and retention of components is an attractive, but often ineffective strategy for the treatment of a total knee arthroplasty (TKA) with acute infection. Few studies have stratified the outcomes of debridement specifically according to bacterial species. Thirty-one TKAs with acute gram-positive infections, seen at our institution during the past 10 years, were treated with open debridement, component retention, and antibiotics. The average duration of symptoms before debridement was 9 days (range, 1-40 days), and 78% of debridements were done within 10 days of the onset of symptoms. Eleven (35%) of the 31 patients successfully retained their components at most recent followup, without ongoing infection (mean, 4 years; range, 2-10 years). Only one (8%) of the 13 who had an infection with Staphylococcus aureus was treated successfully, compared with 10 (56%) of 18 patients who had infections, with either Staphylococcus epidermidis or a streptococcal species. The difference between these groups is statistically significant. The success rate of debridement of acute infections in TKA varies significantly depending on the involved pathogen. A high failure rate suggests that immediate component removal should be considered in the presence of acute Staphylococcus aureus infection in TKA. Debridement for acute streptococcal or Staphylococcus epidermidis species has better success, but likely should be done within 2 to 3 days from the onset of symptoms.

Acute Disease↗
PubMed2003

Preoperative use of recombinant human erythropoietin before total joint arthroplasty.

BACKGROUND: Previous reports have suggested that the use of recombinant human erythropoietin is effective for decreasing the need for perioperative allogeneic blood transfusion. The purpose of this study was to evaluate the efficacy of erythropoietin in combination with, and compared with, preoperative autologous donation for reducing allogeneic blood requirements for total joint arthroplasty. METHODS: Two hundred and forty patients undergoing primary and revision total hip or knee arthroplasty were enrolled into three groups with different treatment regimens: (1) erythropoietin and preoperative autologous donation (Group 1), (2) erythropoietin alone (Group 2), and (3) preoperative autologous donation alone (Group 3). Patients were evaluated with regard to requirements for allogeneic transfusion, change from the baseline to the lowest postoperative hemoglobin value, postoperative complications, and adverse reactions. RESULTS: The rate of allogeneic transfusion was 11% in Group 1 (erythropoietin and preoperative autologous donation) compared with 28% in Group 2 (erythropoietin alone) and 33% in Group 3 (preoperative autologous donation alone). Within Group 1, patients who had a unilateral primary arthroplasty had an allogeneic transfusion rate of 4% and those who had a bilateral or revision arthroplasty had an allogeneic transfusion rate of 17%. In Groups 2 and 3, the allogeneic transfusion rates were 14% and 15%, respectively, for the patients who had a unilateral primary arthroplasty and 35% and 47%, respectively, for those who had a bilateral or revision arthroplasty. CONCLUSIONS: Preoperative use of erythropoietin in conjunction with preoperative autologous donation reduces the need for allogeneic blood transfusion associated with total joint arthroplasty more effectively than does either erythropoietin or preoperative autologous donation alone.

Aged↗
PubMed2003

Simultaneous revision and contralateral primary total knee arthroplasty.

BACKGROUND: There is controversy regarding whether simultaneous or staged bilateral total knee arthroplasty should be performed in patients with bilateral gonarthrosis. In addition, revision total knee arthroplasties have been less successful than primary arthroplasties. The purpose of this study was to evaluate the results of simultaneous revision and contralateral primary total knee arthroplasties performed during the same setting. METHODS: The study cohort included 150 knees in seventy-five patients who had undergone revision arthroplasty because of aseptic failure of a total knee arthroplasty and a contralateral primary arthroplasty for severe gonarthrosis under the same anesthetic. The study group was compared with a control group of sixty patients who had severe arthritis in one knee and had undergone unilateral revision total knee arthroplasty on the contralateral side. The duration of follow-up averaged five years in the group treated with the simultaneous arthroplasties and eight years in the control group. Clinical and radiographic results were evaluated with the Knee Society rating system. RESULTS: In the study group, the average knee score improved by 48 points on the side of the primary arthroplasty and by 37 points on the side of the revision. At the last follow-up visit, most (sixty-five) of the seventy-five patients stated that the knee with the revision felt better than the knee with the simultaneously performed primary arthroplasty. In the control group, the average knee score improved by 30 points on the side of the revision arthroplasty. However, forty-five of the sixty patients had a primary total knee arthroplasty on the contralateral side within two years after the index revision arthroplasty; by four years, all sixty patients had undergone a contralateral primary arthroplasty. CONCLUSIONS: We found a favorable outcome in patients who had undergone simultaneous revision and contralateral primary total knee arthroplasties. Despite a lower mean knee score and less motion, most patients seemed to prefer the knee with the revision arthroplasty to the knee with the primary procedure. These results suggest that this combined procedure is a safe and favorable alternative to a staged procedure consisting of revision and subsequent contralateral primary total knee arthroplasty.

Aged↗
PubMed2003

The spectrum of prosthesis design for primary total knee arthroplasty.

Many types of prostheses are currently used for total knee arthroplasty. Controversy exists, however, regarding which prostheses are the most appropriate for use by individual surgeons and specific patient groups. Six types of prostheses are currently being used in the United States for primary total knee arthroplasty: posterior cruciate ligament-retaining prostheses; posterior cruciate ligament-substituting prostheses; prostheses with ceramic components; mobile-bearing prostheses; nonmodular, compression-molded polyethylene prostheses; and medial-pivot prostheses. The historical and current result of using these different types of prostheses are discussed, and the indications, contraindications, and recommendations for each type are delineated.

Anterior Cruciate Ligament↗
PubMed2002

The association between knowledge of hepatitis C virus status and risk behaviors in injection drug users.

AIMS: The three primary objectives of this study were (1) to document the prevalence of the hepatitis C virus (HCV) and awareness of one's status in a sample of street-recruited injection drug users (IDUs); (2) to compare the drug use and HCV risk behaviors of IDUs who reported that they were HCV infected with those who were unaware of their status and subsequently tested positive for HCV antibodies; and (3) to assess associations between risk factors and HCV status by comparing those who tested positive with those who tested negative. DESIGN: IDUs responded to structured interview questions assessing HCV risk behaviors and were offered a free HCV test. SETTING: Subjects were recruited through street outreach in Denver, CO, USA. PARTICIPANTS: Participants were current, out-of-treatment IDUs. MEASUREMENTS: A modified version of the Risk Behavior Assessment (RBA) and HCV test results were used. FINDINGS: Of the 197 participants, 20% had been diagnosed previously with HCV. Of those who did not know their status, 61% tested positive for HCV antibodies. Those who knew they were positive had been injecting longer but engaged in fewer HCV risk behaviors than those who did not know their status. Compared to those who tested negative, those who tested positive were more likely to be male, non-white and older. They also had been injecting longer, were more likely to use heroin and/or crack cocaine and consumed more alcohol. CONCLUSIONS: In this study, a very large proportion of injection drug users who had hepatitis C were unaware of it, and they were engaging in more risk behaviors than those who were aware of their positive status. Risk factors associated with positive HCV status were identified so that those who are most at-risk for HCV might be targeted for testing and subsequent prevention or care.

Adolescent↗
PubMed2002

Total knee arthroplasty in the obese patient: tips and quips.

As defined by body mass index, 1 of every 3 Americans is overweight. The excuses and reasons for this situation are genetic, dietary, cultural, and physiologic. Scandinavian literature has shown a higher incidence of gonarthrosis in obese patients and some indication of decremental surgical results. Patient selection requires identification of the distribution of the obesity and its implications for knee surgery. Anesthetic techniques should stress regional approaches, oxygenation, and modified postoperative regimens. Surgical incisions should be midline, should be longer than normal, and should involve eversion of the patella within its fat envelope. Increased tourniquet length and width are mandatory. Although wound complications are more common, the overall statistics from total knee arthroplasty in obese patients are not discouraging. Greater pressure is placed on the surgeon to achieve perfect alignment and balance because the patient's weight could unmask the imperfections of the arthroplasty. Only 18% of obese people lose weight after joint replacement.

Arthritis↗
PubMed2002

Haemophilus influenza infection complicating a total knee arthroplasty.

Haemophilus influenza is rarely a cause of septic arthritis in adults. It has not been reported as a cause of infection in total knee arthroplasties. Haemophilus influenza septic arthritis is a late stage, hematogenous infection. A 43-year-old woman with a history of rheumatoid arthritis was found to have Haemophilus influenza infection 3 years after the index total knee arthroplasty. The patient was treated with debridement and systemic antibiotics. At the 5-year followup, the patient was comfortable and free of clinical signs of infection. This approach was successful at eradicating infection and salvaging the total knee arthroplasty.

Adult↗
PubMed2002

A comparison of stemmed and unstemmed components in revision knee arthroplasty.

The purpose of the current study was to compare retrospectively the results of the Insall-Burstein constrained condylar knee implant used with and without intramedullary stems in 207 revision knee arthroplasties with the Insall-Burstein constrained condylar knee implant. One hundred sixty-one knees had either one or two stems placed. One hundred eight femoral stems and 76 tibial stems were placed. Fifty-five knees had no femoral or tibial stem. The average knee scores ranged from 52 preoperatively to 86 postoperatively. The average range of motion postoperatively was 4 degrees (range, 0 degrees -10 degrees ) to 106 degrees (range, 94 degrees -118 degrees ) in this group. The average postoperative knee score was 86 in the unstemmed group and 85 in the stemmed group with no difference in average range of motion. There were four (3%) cases of tibial loosening and two (2%) cases of femoral loosening in the unstemmed group. There were two (2%) cases of tibial loosening and two (2%) cases of femoral loosening at an average followup of 4.2 years (range, 2-6.2 years). Despite the higher constraint inherently designed in an Insall-Burstein constrained condylar knee component, the current study did not show a significantly higher loosening in implants without stems compared with implants used with stems. Therefore, the use of a semiconstrained component does not alone constitute a requirement for the use of an intramedullary stem.

Adult↗
PubMedDate not supplied

Drug injectors and dealers in Odessa, Ukraine.

This article reports on the results observed in a series of focus groups and in-depth interviews with injection drug users (IDUs) and drug dealers in Odessa, Ukraine. Ukraine has the highest rate of HIV infection in Eastern as well as Western Europe, and Odessa ranks among the cities in that country with the highest seroprevalence. The epidemic is largely concentrated among IDUs, although heterosexual transmission is increasing. The purpose of this study was to further understand the context in which HIV-related risk behaviors occur in order to recommend intervention strategies that might reduce the rate of new infections. The drug users who participated in the research were impoverished and severely addicted. Findings revealed that there were two sources for drugs in Odessa: either from gypsies in preloaded syringes, or from drug dealers also in a liquid form. The most common drug injected was liquid poppy straw, a weak opiate known as "hemia." Results showed widespread victimization of drug users by police officials, leading to increased risk-taking to avoid arrest or harassment. Needle/syringe sharing was common and users rarely had time to disinfect their works. The most common product used to clean was urine, believed to be an antiseptic. When asked to recommend prevention strategies to reduce the rising rate of HIV, the most common response by the users and dealers was to legalize drugs. The drug and HIV epidemics in Odessa, as well as all of Ukraine, call for urgent public health measures to impact and improve the health of its citizens.

Adult↗