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Biomedical subjects

William T Long

Publications and source records attributed to William T Long.

9 recordsLinked to original sources
PubMed2007

Psychologic reasons for patients preferring minimally invasive total hip arthroplasty.

Success of an orthopaedic operation depends on patients achieving their primary goal(s) and having satisfaction with the outcome. The enthusiasm of patients for minimally invasive total hip arthroplasty seems related to satisfaction with the operation. We hypothesized patients' attitude toward a small incision would increase their confidence and satisfaction with the operation but the importance of the incision would dissipate after patients realized their goals of pain relief and functional recovery. One hundred sixty-five patients responded to a 14-question patient-perception questionnaire preoperatively and 6 weeks postoperatively and a followup survey at 6 months to 1 year postoperatively. One hundred nine patients had small incisions (mean, 9.6 cm) and 56 had long incisions (mean, 17.9 cm). Preoperatively patients expected small-incision surgery would positively influence their primary goals and satisfaction; at 6 weeks postoperative they believed more strongly that this was true. By 6 months to 1 year, the importance of the incision diminished because 100% of patients met their primary goals. Forty percent of patients with a long incision were not satisfied and the reasons given were related to the process of reincorporating their injured hip into their whole-body image. We confirmed our first hypothesis that a small incision influences a patient's satisfaction postoperatively; we could not confirm our second hypothesis that incision length did not matter after attaining primary goals.

Arthroplasty, Replacement, Hip↗
PubMed2005

Periprosthetic femoral fractures associated with contralateral hip disease.

Femoral osteolysis associated with contralateral hip degenerative changes is a risk factor for ipsilateral periprosthetic femoral fracture. We report 5 comminuted proximal shaft fractures around loose femoral implants occurring in patients with both symptomatic femoral lysis and a painful hip on the other side. Our evolving strategy involves timely revision surgery once this pattern is recognized. Once fracture has occurred, emergent revision requires extensive medical evaluation, availability of long-stem revision implants, and appropriate instrumentation and allografts for fracture fixation.

Adult↗
PubMed2005

Metal-on-metal: articulations for the new millennium.

Implants with metal-on-metal articulations (Metasul, Sulzer Medica, Winterthur, Switzerland [now Zimmer, Warsaw, IN]) have been used in nearly 300,000 total hip replacements. In three different clinical studies, clinical success has been demonstrated using this implant as measured by Harris hip scores, patient self-assessment, and assessment of mechanical complications. Of a study group of 924 patients who received this implant, the only reported complications were mechanical, incldding two cup loosenings (0.2%) and 36 dislocations (4.0%). In a randomized study, clinical resultsfor the group that received implants with metal-on-metal articulation were comparable to those of the ceramic-on-polyethylene (control) group. Reports assessing retrieved implants with metal-on-metal articulation demonstrate low annual linear wear rates and no consequences of elevated cobalt ion levels at follow-up from 4 years to 26 years. In light of these data, the continued ise of metal-on-metal articulations is recommended for any patient who does not have compromised renal function.

Arthroplasty, Replacement, Hip↗
PubMed2005

The clinical performance of metal-on-metal as an articulation surface in total hip replacement.

The metal-on-metal articulations in total hip arthroplasty (THA) were widely used between 1960 and 1975. The McKee-Farrar and other first-generation prostheses failed at a high rate because impingement caused early component loosening. The problem of early component loosening was corrected by improved component design and better manufacturing quality. Second-generation metal-on-metal total hip replacements have experienced short and medium-term success as assessed by Harris Hip Scores and patient self-assessment. The combined annual linear wear of the metal-on-metal femoral head and acetabular insert is less than 10 mm and osteolysis has only rarely been observed in association with well-fixed metal-on-metal total hip replacements. Hypersensitivity is not a common cause of loosening with second-generation hip replacements and remains to be proven as a definitive diagnosis in unusual cases of unexplained pain. More than 40 years of use has demonstrated no increase in the incidence of renal failure or cancer in patients with metal-on-metal total hip replacements. The scientific evidence of the results using the metal-on-metal articulations would recommend its continued use in any patient who does not have compromised renal function.

Arthroplasty, Replacement, Hip↗
PubMed2004

Sarcoidosis.

A 48-year-old woman with an 8-year history of intermittently pruritic papules on the lower extremities suddenly developed pruritus and generalized spread of the lesions over a 1-month period. The lesions appeared as smooth, flat-topped, violaceous, round papules on all extremities, trunk, and back. A biopsy specimen showed sarcoidosis. Cutaneous sarcoidosis has many morphologic presentations and often mimics other dermatologic diseases. Despite widespread cutaneous involvement, she has no systemic involvement. Treatment options are reviewed.

Female↗
PubMed2004

An American experience with metal-on-metal total hip arthroplasties: a 7-year follow-up study.

This study reviews the clinical performance of 161 hip arthroplasties (154 patients) with the Metasul metal-on-metal articulation and an uncemented modular acetabular component. Between 1995 and 2002 clinical evaluation and radiographic follow-up of patients included Harris hip scores, patient self-assessment, and radiographs. Twelve operative site complications (7.5%) included 6 revision operations, (3.7%) and 3 other complications (1.9%) not needing reoperation. Six revision operations (3.7%) included 1 femoral revision for aseptic loosening (0.06%) and 5 acetabular revisions (3.1%). One cup revision was for recurrent dislocation, 1 for disassociation of the acetabular insert from the cup, 1 for infection, and 2 for unexplained pain. Histologic evidence did not support the diagnosis of metal hypersensitivity in either case of unexplained pain, and 1 had relief following spine surgery. A focal radiolucency, identified as calcar resorption, was observed in 9 patients.

Adult↗
PubMed2004

The argument for the use of Metasul as an articulation surface in total hip replacement.

Metasul metal-on-metal articulations have been used for 15 years in approximately 300,000 total hip replacements. We have used Metasul articulations in three clinical studies and have shown clinical success as measured by Harris hip scores and patient self-assessment; we also have had the usual mechanical complications. The only complications have been mechanical, including two cup loosenings and 24 dislocations in a total of 582 patients (619 hips; 3.8%) who had Metasul articulations and were included in these studies. In the randomized study, the group who had Metasul articulations had no clinical results or complications different from the control ceramic-on-polyethylene group. Authors of retrieval results in the literature report low annual linear wear rates and no consequences of elevated Co ion levels. Currently, the scientific evidence of the results of using the Metasul articulation would recommend its continued use in any patient who does not have compromised renal function.

Adult↗
PubMed2003

Grading system for gunshot injuries to the femoral diaphysis in civilians.

One hundred patients had surgical treatment for a gunshot injury to the femur at the authors' hospital. Each injury was classified (Grade 1-3) based on clinical and radiographic signs of deep soft tissue necrosis. All patients were followed up for a minimum of 6 months (average, 18 months; range, 6 months-72 months). Grade 1 injuries are defined by small entry and exit wounds (< 2 cm) and the absence of high-energy characteristics on plain radiographs. Grade 2 gunshot injuries have small wounds (< 5 cm) and radiographic evidence of a high-energy injury. Grade 3 gunshot injuries are diagnosed by physical examination whenever necrotic muscle is present at the fracture site. Radiographs show extensive superficial and deep soft tissue disruption and segmental bone destruction. Seventy-nine patients with Grade 1 fractures had intramedullary nailing without wound exploration; all fractures united without infection. Seven patients with Grade 2 injuries had wound exploration; a necrotic cavity was discovered in five patients and three (43%) patients had deep infection develop. Fourteen patients with Grade 3 injuries had one or more debridements followed by skeletal stabilization, and seven patients (50%) had deep infection develop. Important decisions regarding wound debridement and fracture stabilization are determined by examination of the wound and radiographs, and not by determining muzzle velocity.

Adolescent↗