The use of polycentric knee arthroplasty in the treatment of fracture deformities of the knee.
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Adult↗
Biomedical subjects
T H Mallory
Publications and source records attributed to T H Mallory.
Linking the orthopaedic office-hospital continuum: results before and after implementation of an automated patient health history project.
This article introduces an innovative collaboration between an orthopaedic surgeon's office and the hospital to assure complete and accurate admission information without duplication. With the use of point-of-care software, the assessment process was re-tooled. This change involved the patient/family assuming responsibility for completing paper and pencil in-depth history and systems review that was then used as part of the evaluation process and inputted into the database allowing for more effective outcomes assessment. In this re-tooling process, the concept of "sharing" information with the partnering hospital was explored. In collaborative discussions, the nursing admission assessment was targeted as a process where there was significant duplication. In fact, much of the information required on the 4-page form was already assessed and documented in the office setting. Consequently it was agreed that the majority of the inpatient nursing history/admission assessment form would be replaced with the assessment completed by the professional office staff. Because of incompatible software, the systems could not be linked but a printed copy of the form was sent to the hospital. Results measuring satisfaction, timesaving, and compliance with JCAHO documentation standards were part of the evaluation. Patients and clinicians were satisfied with the process. There was a significant timesaving for the in-patient RN which facilitated more direct contact with the patient and family.
Automation↗
Posterior buttock pain following total hip replacement. A case report.
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Acetabulum↗
Dislocation after total hip arthroplasty. Treatment with an above-knee hip spica cast.
A study was undertaken of 32 dislocations occurring during a nine-year period in 25 of 1280 postoperative total hip arthroplasty patients. Dislocations occurred in 0.6% of 1030 primary procedures, 1.6% of 165 conversions of hemiarthroplasties to total arthroplasties, and 20% of 85 revisions of previous total hip arthroplasties. Average time to dislocation was 31 days after primary procedures and 106 days after revisions. Acetabular cup malposition and poor patient cooperation appeared to be the causes of dislocation after primary procedures. Trochanteric absence or compromise was a factor in dislocation after revision. Treatment consisted of 13 closed reduction and 19 open reductions. An above-knee hip spica cast was employed for six weeks following closed or open reduction in 16 patients. These 16 patients have been followed up for an average of 32 months (28-45 months). Only one redislocation has occurred.
Acetabulum↗
A plastic intermedullary plug for total hip arthroplasty.
Plugging of the medullary canal during total hip replacement creates better cement fixation and thereby prevents subsequent loosening of the femoral component. Methods of plugging involve the use of cement or bone plugs. Both methods have limitations, are time-consuming and can bae ineffective. A high-density polyethylene plug is convenient material for plugging the medullary canal. Laboratory studies show that the plug generates an intramedullary pressure when the proximal femoral canal is being cemented. In 50 patients undergoing total hip replacement, this bullet effectively restricted the cement cone of the proximal femur. The method of insertion was simple, efficient and expedient.
Bone Cements↗
Unicompartment total knee replacement: a 2--4 year review.
Unicompartment total knee replacement is a controversial operation. Conflicting reports indicate that there is unacceptable wear associated with loosening. To investigate the problem, 21 patients were examined 2--4 years after the operation. Eighty-one per cent of the patients were free of pain. None of the remaining patients had disabling pain. All patients demonstrated 90 degrees or greater range of motion with 91% of the patients' preoperative deformity completely corrected. There was a 19% evidence of X-ray loosening of the component which was consistently associated with the clinical symptoms of mild pain. Unicompartment total knee replacement is an acceptable alternative to high tibial osteotomy and relieves pain as well as corrects deformity.
Aged↗
The evolution of the Buck-32 total hip prosthesis.
The total hip prosthesis designed by Buchholz has had an excellent clinical record. Despite its unique features, popularity in the United States has been lacking because of the large head size and the single-size neck length. The Buck-32 modification offers a 32 mm head with varying neck lengths, but retains the salient features of a longer stem and a ventral recess in the acetabular component. Laboratory studies demonstrate that the modified Buchholz prosthesis (Buck-32) does demonstrate an excellent range of motion, superior strength qualities, and excellent flexibility which allows its use in clinical conditions requiring maximum prosthetic strength.
Biomechanical Phenomena↗
Excision arthroplasty with delayed wound closure for the infected total hip replacement.
Methods of management of infections in total hip replacement vary from the use of antibiotics with reimplantation to a complete removal of the prosthetic unit. This is a series of 10 consecutive patients having documented sepsis following total hip replacement characterized by gram-negative organisms which was managed with the method of excision (Girdlestone) arthroplasty with delayed wound closure. Parenteral antibiotics were used while the wound remained open. Once wound healing had been accomplished, the patients were placed on appropriate oral antibiotics and continued on same for approximately 6 months. The duration of follow-up was 3-5 years. All patients have continued to remain free of clinical sepsis. One patient has chronic pain. All patients are fully ambulatory and are fully satisfied with their functional capacities. Recognizing a serious infection following total hip replacement, especially characterized by the presence of gram-negative organisms, requires drastic treatment methods. Excision arthroplasty with delayed wound closure is a reasonable alternative, especially in view of the functional results obtained.
Anti-Bacterial Agents↗
Uni-compartment total knee replacement.
Twelve patients with uni-compartment total knee replacement were followed for a period of 12 to 30 months with an average follow-up of 19 months. Results in 11 out of 12 patients suggest that this operation is an alternative to high tibial osteotomy or hemiarthroplasty in selected patients. Long term end result studies are necessary to evaluate uni-compartment total knee replacement as a durable procedure for the management of knee arthritis.
Arthritis↗