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Biomedical subjects

T H Mallory

Publications and source records attributed to T H Mallory.

At least 55 records · Page 3Linked to original sources
PubMed1993

Translateral surgical approach to the hip. The abductor muscle "split".

A modified translateral approach to the hip, "the abductor muscle split", has been used when performing primary total hip arthroplasty. The results of this surgical approach in 50 patients with an average follow-up period of 2.8 years showed excellent restoration of abductor muscle function and gait without compromising surgical exposure. There was one case of postoperative dislocation. Heterotopic bone formation was not a clinical problem.

Aged↗
PubMed1993

Specialization.

Explore the source record for details and available documents.

Humans↗
PubMed1992

Surgical exposure and cement removal in revision total hip arthroplasty.

The surgical approach in revision total hip arthroplasty (THA) must conform to the preoperative goals of revision surgery. Factors to be considered include adequate visualization, assessment of remaining bone stock, presence or absence of cement, status of the trochanter, leg length discrepancies, and previous surgical approaches. To maintain neurovascular structures, blood supply to the involved bone, postoperative abductor function, stability, and gait normalcy, an anterolateral approach is best used. Three anterolateral approaches are used to address various aspects of revision THA. Approach 1 allows for exposure of the acetabulum and proximal femur. The associated abductor muscle split allows for excellent proximal exposure. Approach 2 is performed when acetabular reconstruction is neither complex nor involved, and when extended access to the femur is necessary. The lateral-distal incision is determined by the need for adequate femur exposure for implant removal, cement removal, and any bone grafting procedures to reconstitute osseous structures. Approach 3 is further developed proximally to expose necessary anatomic regions of the acetabulum while preserving the underlying neurovascular structures. Using special instrumentation and controlled femoral perforations, cement mantles are quickly removed, minimizing damage to the bone and preserving the osseous structures. For all three approaches, abductor muscle separation repair and/or reattachment is performed with a heavy, no. 5, nonabsorbable suture. Postoperative patient management depends on the degree of dissection and extent of reconstruction.

Bone Cements↗
PubMed1992

Clinical and radiographic experience with a hydroxyapatite-coated titanium plasma-sprayed porous implant.

Recent efforts to improve the interface between implant and bone have involved the use of bioactive materials, specifically hydroxyapatite (HA). HA coatings applied to implants have shown excellent clinical results at 2 years. There have been no radiolucent lines around the HA-coated implants. The long-term strength of the HA coating-substrate bone interface remains a concern as osseointegration of the HA appears to be a consistent phenomenon. This can lead potentially to an interruption between the substrate itself and the osseointegrated coating.

Durapatite↗
PubMed1991

An evaluation of the efficacy of postoperative blood salvage after total joint arthroplasty. A prospective randomized trial.

The efficacy of a postoperative blood salvage system was assessed in 239 consecutive patients undergoing total knee or total hip arthroplasty. Patients were randomly allocated to either a control group using a standard drainage system or to the study group using the Solcotrans blood salvage canister. The median amount of homologous blood required after operation by the study group was reduced by 74% from the amount required by the control group (mean, 67 ml vs 256 ml, respectively; P less than .0001). Thirteen percent (13%) of the study group required postoperative homologous blood transfusions, as compared to 39% of the control group (P less than .0001). Additionally, patients in the study group had higher hemoglobin levels beginning on the first postoperative day. This study indicates that a postoperative blood salvage system safely and effectively reduces the amount of homologous blood required and sustains higher hemoglobin levels after operation.

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PubMed1991

Knee manipulation following total knee arthroplasty. Analysis of prognostic variables.

In an effort to identify prognostic indicators for knee manipulation, the authors retrospectively reviewed the records of 60 osteoarthritic patients with posterior stabilized knee implants who required manipulation (94 knees) between January 1984 and December 1986. They also studied the records of 28 consecutive osteoarthritic patients who were implanted with 41 posterior stabilized knees between January 1985 and September 1985 whose knees did not require manipulation (control group). In both patient groups the following parameters were assessed and compared: overall knee alignment, joint line elevation, anterior to posterior (AP) dimension of the knee, AP placement of the tibial component, patellar height, obesity, age, preoperative flexion, time of manipulation, single vs bilateral knee implants, final flexion, final Hospital for Special Surgery (HSS) score, and the development of heterotopic ossification. The findings of this study showed that an increase in the AP knee dimension by 12% or greater was a critically independent variable that significantly predisposed patients to manipulation. They also show that quadriceps adhesions were another major factor leading to manipulation, and that rupturing of these adhesions led to an increase in heterotopic ossification. This review also indicated that 3 months after knee arthroplasty was a significant time for evaluation because knee flexion and HSS score at this point in the patient's recovery positively correlated with the final HSS score.

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PubMed1991

Clinical and radiographic experience with a hydroxyapatite-coated titanium plasma-sprayed porous implant.

The use of bioactive materials recently has given increased hope to achieving adequate fixation in cementless total hip arthroplasty. Hydroxyapatite, one of the most biocompatible materials known, interacts with surrounding bone and forms a chemical bond with the bone, rather than a mechanical microinterlock via bioingrowth. There is direct bonding of bone and the hydroxyapatite, as opposed to the development of an intervening fibrous tissue layer between the implant and the bone. Recent use of hydroxyapatite-coated implants has shown that very strong bonds with living bone occur within a relatively short period of time. In this article, 53 primary, cementless total hip arthroplasties, all performed by or under the direction of a codesigner of the prosthetic system, are reviewed. The average age of the patients at arthroplasty was 51 years; the follow-up period averaged 17 months. The preliminary results achieved in this group of patients were compared with those achieved in 50 patients who received the identical porous coated implant without hydroxyapatite. The preoperative diagnoses, Harris Hip Scores, and patient demographics were similar for both groups. A comparison of clinical results showed that patients with the hydroxyapatite-coated femoral implants experienced more rapid clinical improvement in the first 6 to 10 weeks after arthroplasty than the patients with the identical prosthesis without hydroxyapatite coating. Radiographically, in the hydroxyapatite group, there have been no femoral or acetabular component failures, and no instances of femoral component subsidence or acetabular component migration.

Female↗
PubMed1991

A comparison of intramedullary and extramedullary alignment systems for tibial component placement in total knee arthroplasty.

Fifty-two primary total knee arthroplasties (TKAs) using an intramedullary tibial jigging system to obtain ideal tibial alignment (90 degrees +/- 2 degrees) were compared with 62 TKAs using an extramedullary tibial jigging system. The Insall-Burstein total knee system was used in all cases, and all femoral components were positioned with extramedullary jigs. Postoperative evaluation consisted of a standing, hip-to-ankle anteroposterior roentgenogram and measurement of the following angles: (1) femorotibial, (2) tibial component, (3) femoral component, and (4) mechanical axis. Ideal tibial component alignment using the intramedullary system was statistically superior to alignment achieved with the extramedullary system. All other angle comparisons showed no statistical significance.

External Fixators↗
PubMed1991

The efficacy of suction drains after routine total joint arthroplasty.

A prospective study of thirty-eight patients (seventy-six knees) who had had a primary bilateral total knee replacement and twelve patients (twenty-four hips) who had had a primary bilateral total hip replacement was conducted to assess the effect of postoperative suction drainage on wound-healing. A suction drain was placed on each patient's right operative wound, while no drains were used on the left. Otherwise, the same operative technique and method of closure were used in all wounds. Statistical analysis of the results showed no difference between the two sides with regard to the incidences of swelling or persistent drainage. Return of active function of the quadriceps and of range of motion of the knee in patients who had had a total knee replacement was also unaffected by the use of suction drains. We concluded that the routine use of suction drains for wounds is unnecessary after uncomplicated total joint arthroplasty.

Follow-Up Studies↗
PubMed1991

Preliminary report on the S-ROM constraining acetabular insert: a retrospective clinical experience.

The incidence of dislocation after total hip arthroplasty is significantly higher after revision and in patients with neuromuscular or other complications. To prevent dislocation, 55 patients with multiply revised total hip arthroplasties, unstable hips, and neuromuscular and/or neurologic conditions associated with total hip arthroplasty received implants with the S-ROM constraining acetabular insert. With an average follow up of 30.2 months, 50 patients have not experienced redislocation after insertion. Before S-ROM, our dislocation rate in 176 revision total hip arthroplasties was 19%, but is now 4.5% (P less than .001).

Acetabulum↗
PubMed1990

Empirical considerations in orthopaedic research design and data analysis. Part I: Strategies in research design.

Empirical investigations have a direct effect on future therapeutic interventions. Thus, the advancement of any field of medicine is dependent upon the critical evaluation of research. Careful research design by investigators is necessary to yield meaningful, significant data. A clear understanding of basic statistical relationships is necessary for the clinician to evaluate the significance and quality of the scientific literature.

Humans↗
PubMed1990

Empirical considerations in orthopaedic research design and data analysis. Part II: The application of data analytic techniques.

To assure that a hypothesis is tested as rigorously as possible, the proper statistical method must be used to analyze the data. But without a strong background in statistics, it may be difficult to determine the efficacy of the data analytic technique used in the study. This paper describes several widely used data analytic techniques and offers examples of their proper application in orthopaedic research design.

Data Interpretation, Statistical↗
PubMed1990

Empirical considerations in orthopaedic research design and data analysis. Part III: Multivariable analysis.

To make a contribution to a base of knowledge, research design must be sound and the data must be analyzed by the most efficient, powerful method available. In conducting orthopaedic research as well as when interpreting the orthopaedic literature, knowledge of multivariable analysis is essential in evaluating the effects of variables that may confound or influence the relationship of interest. An understanding of the basic tenets, underlying assumptions, and purposes of frequently used types of multivariable analysis is necessary for an accurate, critical evaluation of a study's results.

Humans↗
PubMed1990

Impedance plethysmography for surveillance of deep venous thrombosis following early discharge of total joint replacement patients.

Between April 1988 and February 1989, 877 patients undergoing total hip (394 patients) and total knee (483 patients) replacement surgeries were given warfarin prophylaxis perioperatively and were tested with impedance plethysmography (IPG) approximately 17 days postoperatively (10 days post-discharge) in the outpatient office. There were 69 positive IPG tests (7.8%). Further assessment of patients with positive IPG results using duplex scanning or venography confirmed DVT in 25 of the 69 patients (3.6%) in the popliteal or thigh areas, and ruled out venous disease in 44 patients. All 25 patients were readmitted for anticoagulation therapy with intravenous (IV) heparin and warfarin. There were no cases of pulmonary embolus. This study indicates that IPG testing is a safe and effective method of screening patients for DVT and its potentially fatal sequela of pulmonary embolus. Furthermore, IPG testing has proven to be cost effective, as it is a relatively simple procedure which can be administered by non-professional personnel in the outpatient office setting.

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PubMed1990

Evaluation of the design and clinical performance of cementless acetabular components.

Three hundred four cementless acetabular components: 54 Ceramic (Richards Medical Co, Memphis, TN); 33 T-Tap (Richards Medical Co); 22 MHP, (Biomet Inc, Warsaw, IN); 109 PCA (Howmedica, Rutherford, NJ), and 86 S-ROM SuperCup (Joint Medical Products Co, Stamford, CT) were implanted in 271 patients between October 1982 and June 1986. Two hundred forty-one hips had good to excellent Harris hip scores, although a significant difference was found when the scores of patients with conical threaded cups were compared with those of patients who had hemispheric porous ingrowth cups and the SuperCup. Also, patients with conical threaded cups had a greater incidence of groin and buttock pain (P less than .01) and underwent more revision procedures (P less than .01). Our clinical and radiographic review indicates that all cementless acetabular cups are not equal and the hemispheric porous cups and hemispheric porous cups with peripheral threads are far superior to conical threaded cups.

Acetabulum↗
PubMed1990

Results of total hip replacement using porous coating as a fixation mode.

Successful cementless total hip arthroplasty is dependent on initial stabilization at the bone-prosthesis interface. Other factors, such as the adaptability of the prosthetic design to fit specific bony geometries, affect clinical outcome. These design considerations have been incorporated into the Mallory-Head (Biomet Inc., Warsaw, IN) prosthetic system so that it allows for immediate rigid stabilization of both the acetabular and femoral component in an effort to optimize the potential for bone ingrowth. Fifty primary cementless total hip arthroplasties, all performed by or under the direction of a codesigner of the prosthetic system, are reviewed. The average age of the patients was 53 years; the follow-up range was 24 to 52 months. The predominant preoperative diagnosis was osteoarthritis (88%). Using the Harris hip score, a noted improvement was seen in the preoperative score of 37 to a postoperative score of 94. Ninety-seven percent of the patients reported no pain or discomfort. In the Engh fixation scale, all femoral components were rated as optimum with signs of bone ingrowth. Radiographic evaluation showed no subsidence or shift of the femoral components. Five patients were noted to have acetabular migration of 4 mm to 6 mm. However, all were asymptomatic and fully functional in daily living activities. The early results of this cementless design compare favorably with those of similar series of cementless total hip arthroplasties.

Age Factors↗