Biomedical subjects

S H Stern

Publications and source records attributed to S H Stern.

At least 37 records · Page 2Linked to original sources

PubMed1992

Total knee arthroplasty in elderly patients. Comparison of tibial component designs.

The authors examined 98 total knee arthroplasties in 73 patients who were 80 years of age or older at the time of surgery (average, 82 years; range, 80-90 years). The follow-up period averaged 4.5 years (range, 2-12 years). The patients were divided into two groups based on their tibial component design. There were 38 all-polyethylene tibial components in 28 patients and 60 metal-backed tibial components in 45 patients. There were 61 (62%) excellent, 30 (31%) good, 2 (2%) fair, and 5 (5%) poor results. Three of the five poor results required revision for septic failure. Of the knees with an all-polyethylene tibial component, 20 (53%) were rated as excellent, 15 (39%) as good, and 3 (8%) as poor. One of these knees rated as poor required revision for septic failure. The knees with a metal-backed tibial tray had 41 (68%) rated as excellent, 15 (25%) as good, 2 (3%) as fair, and 2 (3%) as poor. Both of the knees with poor results required revision for septic failure. Stratifying the results by component composition revealed 97% survival for both types of tibial trays. These results were obtained at 12 years for the all-polyethylene components and at 8 years for the metal-backed prosthesis. In conclusion, the authors believe that total knee arthroplasty is a reliable and durable procedure in the treatment of knee arthritis in the elderly. Elderly patients may represent a special case because they are generally less active than younger patients and may place less stress on their prosthesis.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗

PubMed1992

I-123 iofetamine SPECT scan in systemic lupus erythematosus patients with cognitive and other minor neuropsychiatric symptoms: a pilot study.

Accurate diagnosis of central nervous system (CNS) lupus remains difficult, especially when the manifestations are of subtle cognitive and affective changes. This pilot study reports on the use of I-123 iofetamine single photon emission computerized tomography (SPECT) scans in 18 such patients with documented systemic lupus erythematosus. Eight of the 18 scans were abnormal (44%), four in a diffuse bi-temporo-parietal pattern previously noted only in Alzheimer's disease, and four with large focal deficits. Neither the existence of the abnormal scan nor the particular pattern of abnormality correlated with the results of other diagnostic tests. These preliminary results raise the possibility that SPECT scans may offer an additional valuable diagnostic instrument in CNS lupus, although further studies are necessary to delineate their precise role.

Adolescent↗

PubMed1992

Patellar resurfacing for patellofemoral arthritis.

Knee pain referable to the patellofemoral articulation is common in the general population. It remains a troubling problem for the orthopedic surgeon. Frequently, initial therapy, involving activity modification, anti-inflammatory medications, and isometric quadriceps strengthening, is successful in relieving symptoms. Surgical intervention is normally reserved for those patients with pain that is resistant to these modalities. Unfortunately, none of the various surgical options has proved to be totally dependable, durable, or reproducible. The results of isolated patellar and patellofemoral resurfacing procedures have been guarded. Patellar resurfacing appears to be most beneficial in younger patients with severe anterior knee pain. These individuals should be clearly warned that there is a relatively high likelihood that they will require additional surgical treatment or patellectomy at a later date. Fortunately, patellar resurfacing does not preclude patellectomy from being easily performed. Patellofemoral resurfacing, however, involves more overall involvement of the knee joint. This makes patellectomy less likely to be a successful salvage procedure. Despite our observations that knees with primary patellofemoral arthritis do not do as well after total knee replacement as those with tibio-femoral arthritis, this procedure remains the best treatment option. The durability and predictability of total knee arthroplasty are well documented. Its results far surpass those reported for isolated resurfacing procedures. With regard to patellar resurfacing as part of total knee arthroplasty, we recommend resurfacing all patellae. The literature, although not conclusive, lends support to this practice. Avoidance of metal-backed patellar components and special attention to technical details should decrease the complications associated with patellar resurfacing in future studies.(ABSTRACT TRUNCATED AT 250 WORDS)

Arthritis↗

PubMed1992

Posterior stabilized prosthesis. Results after follow-up of nine to twelve years.

We reviewed, nine to twelve years postoperatively, the records on an original cohort of 289 arthroplasties (218 patients) in which a posterior stabilized knee prosthesis with an all-polyethylene tibial component had been inserted at The Hospital for Special Surgery. One hundred and eighty intact prostheses in 139 patients were available for this analysis. Fourteen knees in fourteen patients had had a revision procedure. Five of these fourteen patients had had a bilateral arthroplasty, but only one knee of each of the five patients had been revised. Forty-eight of the patients (sixty-six knees) had died less than nine years after the operation. Twenty-nine other knees (twenty-two patients) had been lost to follow-up before a nine-year evaluation could be performed. Considering all 194 knees (including the fourteen that had been revised), the result with the system of The Hospital for Special Surgery was excellent for 117 knees (61 per cent), good for fifty-one (26 per cent), fair for twelve (6 per cent), and poor for the fourteen knees (7 per cent) that had been revised. The 180 knees in which the prosthesis was intact were also rated with the new scoring system of The Knee Society: the average postoperative knee score was 92 points (range, 35 to 100 points), and the average score for function was 66 points (range, 0 to 100 points). Survivorship analysis showed that the average annual rate of failure was 0.4 per cent and that the over-all rate of success at thirteen years was 94 per cent.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1991

Effect of chronic carbonic anhydrase inhibitor therapy on bone mineral density in white women.

A limited, dual-photon absorptiometry, single-center study of bone mineral density (BMD) was conducted on white female glaucoma subjects who were chronic users of the carbonic anhydrase (CA) inhibitors acetazolamide (Az) or methazolamide (Mz). In postmenopausal subjects long-term (greater than 4 years) CA inhibitor use was associated with a bone-sparing effect as judged by spinal BMD in comparison to controls matched for age, sex, weight, and ethnic group or in comparison to a national normative data base. Short-term (0-2 years) postmenopausal CA inhibitor users and premenopausal subjects using CA inhibitors showed no sparing of spinal BMD. Femoral neck BMD was not affected by CA inhibitor therapy in any of the groups. This study supports a proposed role for carbonic anhydrase in human bone resorption and suggests a possible future utility for carbonic anhydrase inhibitors in prophylaxis or management of primary involutional osteoporosis. Future studies are necessary to verify and expand these findings, assess the effects of CA inhibitors on bone mechanical competence, and further develop CA inhibitors with some specificity for bone.

Acetazolamide↗

PubMed1991

Sexual function after total hip arthroplasty.

Eighty-six patients who had successful total hip replacement completed questionnaires on their sexual activity. Preoperatively, 46% of patients attributed significant sexual difficulties to their hip disease, whereas only 1% felt that their hips remained a significant source of problems postsurgery. The majority (55%) of patients were able to resume intercourse one to two months postoperation. Male patients were statistically more likely to resume intercourse sooner than their female counterparts. Patients were also questioned about which coital positions they found comfortable after arthroplasty. The supine position (patient on bottom) was the most preferred. The next most comfortable position for males was prone (patient on top), yet for female it was sidelying on the nonoperative hip. In addition, 89% of patients desired more information regarding sexual function postarthroplasty, preferably in the form of a booklet. Therefore, a booklet was written specifically for postoperative patients and their sexual partners.

Adult↗

PubMed1991

Total knee arthroplasty in valgus knees.

One hundred thirty-four total knee arthroplasties in 98 patients with a valgus alignment were analyzed. Knees with a preoperative alignment of 10 degrees or greater anatomic valgus were believed suitable for inclusion. The average follow-up period in these patients was 4.5 years (range, two to ten years). One hundred eighteen knees were implanted with a posterior stabilized prosthesis, eight knees with a constrained implant design, four knees with a total condylar prosthesis, and four knees with a cruciate-retaining design. All components in all knees were cemented. A lateral retinacular release was necessary in 76% of the arthroplasties secondary to intraoperative lateral subluxation of the patella. The ligamentous release for balancing these valgus-deformed knees was done from the femur. There were 95 knees (71%) rated as excellent, 27 knees (20%) as good, eight knees (6%) as fair, and four knees (3%) as poor. Postoperatively, 76% of the knees had a tibiofemoral alignment between 5 degrees and 9 degrees valgus with an overall average of 7 degrees valgus (range, 3 degrees varus to 15 degrees valgus). Total knee arthroplasty is a reliable and durable procedure in the treatment of valgus knee arthritis. However, valgus-deformed knees represent a greater challenge than their varus counterparts to the implant surgeon in terms of the intraoperative balancing required. This may be a function of the greater difficulty in achieving ligamentous equilibrium and the relative rarity of valgus-deformed knees.

Adult↗

PubMed1991

Revision total knee arthroplasty for failed unicompartmental replacement.

The results in nineteen patients (twenty-one knees) who had a failed unicompartmental knee replacement followed by a revision total knee arthroplasty were evaluated. There were twelve excellent, four good, one fair, and two poor results. The interval between the unicompartmental replacement and the revision total knee arthroplasty ranged from eight months to eight years. At the time of the revision, a major osseous defect was found in sixteen knees (76 per cent). The duration of follow-up after the revision ranged from two to ten years. At the most recent follow-up examination, radiographs revealed at least one radiolucent line in thirteen knees (62 per cent). The technical difficulties associated with the revision operation are evidence that unicondylar arthroplasty is not a conservative procedure that allows a total knee arthroplasty to be done easily later. The results also do not support the argument that a revision performed after failure of a unicondylar arthroplasty is less technically demanding than one performed after a failed primary total knee arthroplasty.

Aged↗

PubMed1990

Cemented total knee arthroplasty for gonarthrosis in patients 55 years old or younger.

The results of 68 cemented total knee arthroplasties (TKAs) in 50 patients with gonarthrosis who were 55 years old or younger at the time of surgery were reviewed. These patients were operated on between 1979 and 1987 and were followed for an average of 6.2 years. The average age of the patients was 50 years. Patients were evaluated by the Hospital for Special Surgery knee score. The average preoperative score was 53, and the average follow-up score was 90. Overall, 55 TKAs were rated as excellent and 13 as good. Using the knee rating score advocated by the Knee Society, the average postoperative score was 92 for pain and 84 for function. There were four successful reoperations for patellar component loosening, all in metal-backed patellae. The femoral and tibial components in these patients were intact, and at the follow-up period, two knees were rated as excellent and two as good. Detailed roentgenographic evaluation demonstrated that 20% of tibial components had radiolucencies in at least one zone on the anteroposterior roentgenogram and in 11% on the lateral roentgenogram. Femoral radiolucencies occurred in only 2% of knees. Patellar radiolucencies in one or more zones occurred in 20% of knees that had not had patellar revision. No complete or progressive radiolucencies at the bone-cement interface were noted for any component, and no components were considered to be roentgenographically loose. Cemented TKAs can achieve excellent long-term results in patients younger than 55 years old with gonarthrosis of the knee. These results compare with those obtained in published reports on older age groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1990

Total knee arthroplasty in diabetes mellitus.

A retrospective study was done of 59 total knee arthroplasties (TKAs) in 40 patients diagnosed with diabetes mellitus. The overall infection rate was 7%, with an overall revision rate of 10% and an average follow-up period of 4.3 years. Wound complications were present in 12% of the TKAs. The rate of deep joint infections in diabetic patients was statistically higher than the reported incidence of sepsis in nondiabetic patients. Therefore, maximum precautions should be taken for diabetic patients having TKA to minimize both wound complications and joint sepsis.

Aged↗

PubMed1990

Total knee arthroplasty in obese patients.

We examined 182 patients (257 knees) who had had a total knee arthroplasty two to five six years earlier. The patients were grouped into five weight classes. Eighteen patients (twenty-seven knees) were considered moderately obese and twelve patients (twenty-seven knees), severely obese. The results in all but four knees were rated excellent or good. One patient needed a revision procedure for late infection, and the result was rated poor. Three results were rated fair. There was no discernible difference in the over-all scores among the five weight groups. However, 30 per cent of the knees of the moderately and severely obese patients had patellofemoral symptoms, whereas the incidence was 14 per cent in the other groups (p less than 0.03). No clear-cut association was found between obesity and either thrombophlebitis or complications related to the wound.

Adult↗

PubMed1989

Total knee arthroplasty in patients with psoriasis.

Patients with progressive psoriasis have an increased infection rate when having total joint arthroplasty. Therefore, maximum precautions should be taken in the perioperative period as well as with long-term follow-up care to prevent joint sepsis in these patients. In particular, skin care should be meticulous. Special attention should be given to use of a topical corticosteroid or other dermatologic treatment when total joint arthroplasty is considered.

Anti-Bacterial Agents↗

PubMed1988

Clostridium perfringens infection in a total knee arthroplasty. A case report.

A 66-year-old woman with a painful total knee arthroplasty and turbid fluid aspirates had her prosthesis removed for a presumed diagnosis of infection. The intraoperative cultures were positive for Clostridium perfringens, and the patient did well after a course of intravenous antibiotics prior to reimplantation. Clostridium perfringens is a rare cause of pyarthrosis in both nonoperative and prosthetic joints. This report details the first case of clostridial infection involving a patient with a total knee arthroplasty.

Aged↗

PubMed1988

Immunogenetic and racial determinants of gold toxicity in rheumatoid arthritis.

Typing for antigens HLA-A,B,C and DR was performed on 165 rheumatoid arthritis patients (14 black, 151 white) who had received gold therapy to determine the relationship between HLA antigens and gold dermatitis, stomatitis, thrombocytopenia, and proteinuria. Dermatitis and stomatitis occurred in both black and white patients. Thrombocytopenia and proteinuria occurred only among the white patients studied. The absence of thrombocytopenia and proteinuria among the black patients was not statistically significant. Antigen HLA-DR7 was uncommon among black and white subjects with dermatitis (0 of 6 blacks, 4 of 48 whites), but this decrease in frequency was not statistically significant. Antigen HLA-DR3 was an important risk factor for thrombocytopenia (relative risk = 11.8, P = .0043) and proteinuria (RR = 5.8, P = .032). These results are consistent with previous studies of HLA-DR3 and gold toxicity. The only black patient with stomatitis possessed the A1B8DR3 phenotype. Future studies should examine whether the same HLA antigen confers risk of different gold toxicities in different racial groups, and whether there are HLA antigens that provide a protective effect.

Arthritis, Rheumatoid↗

PubMed1988

Ankle and foot pain.

An approach that allows a consistent, thorough evaluation can be recommended by a mnemonic using the words ankle/foot. The maxim about foot and ankle pain is that "the good exam begins at the back and ends at the toe." During this exam, the cutaneous, vascular, and neural systems need careful evaluation. The exam is directed to the region of maximal discomfort where careful palpation should pinpoint the spot of greatest tenderness. Once this region has been localized and signs and symptoms collected, consider the differential diagnosis specific for that area. This will narrow the focus, make the number of potential pain sources manageable, and often provide the answer. When the diagnosis is still unclear, obtain standard x-rays of the area. A directed evaluation to probe the region is appropriate. This can mean a bone scan to detect early avascular necrosis, stress fractures or osteomyelitis; an EMG-NCS to assess the neural circuitry; and special x-ray views, CAT scan, NMR, or arthrogram to uncover the difficult fracture. At this point, fortunately, the primary physician is not alone. The diagnostic dilemma or the difficult management case can be referred for a second opinion or therapeutic assistance to a podiatrist, rheumatologist, or the orthopedist with a special interest in feet.

Ankle↗

PubMed1988

Tophaceous deposition in the finger pads without gouty arthritis.

Tophi are rarely observed in patients without a prior history of gouty arthritis. We describe four patients whose initial manifestation of gout was tophaceous deposition in an unusual location, the finger pad. None of these patients had a history of acute gouty arthritis and none had tophi elsewhere. All four patients were postmenopausal women with decreased renal function; all were taking diuretics. We conclude that tophaceous gout without arthritis may be more common than previously recognized and that tophi may deposit in the finger pad. We recommend prompt aspiration and crystal analysis of white subcutaneous finger pad deposits in hyperuricemic patients even without a history of gouty arthritis.

Aged↗

PubMed1987

Colchicine in acute gout. Reassessment of risks and benefits.

Colchicine is an effective and relatively specific treatment for acute gout and has a long, venerable history. Serious toxic reactions to colchicine could be prevented if guidelines for its use were followed strictly, but because of its relatively infrequent use and conflicting recommendations, considerable toxic effects might occur and still be undetected by passive surveillance. A review of a teaching hospital's four years' experience showed two deaths (2% incidence) due to inappropriate use. Colchicine has the smallest benefit-to-toxicity ratio of drugs that are effective for acute gout. This article gives specific recommendations for the use of colchicine in different clinical settings.

Administration, Oral↗

PubMed1986

Biomechanical optimization of a model particulate composite for orthopaedic applications.

Particulate composites are a potential solution to the need for an injectable, biocompatible, resorbable material that could be used to reinforce fractures and defects in bone and temporarily to stabilize porous ingrowth prostheses. We have developed a model system for producing and testing particulate composites to determine if mechanical properties suitable for orthopaedic applications can be achieved. The experiments used bovine cortical bone and various forms of hydroxyapatite for the particulate phase and a collagen and particulate reinforce gelatin-resorcinol-formaldehyde (G-R-F) adhesive for the matrix phase. Using unconfined compression testing, we measured the effects of variation in particulate type, size, shape, and volume fraction on the material properties of the particulate composites. We found that compressive strengths greater than 10 MPa and compressive moduli greater than 100 MPa could be achieved in this model system. Rough and irregular particulates exhibited higher compressive strengths and moduli than smooth and spherical particulates. Mechanical properties were largely independent of particulate size in the range of 125-850 microns diameter. This model system suggests that, with the development of new biocompatible matrix materials, particulate composites with mechanical properties suitable for orthopaedic applications can be achieved.

Animals↗