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PubMed1996

Proprioception after unicondylar knee arthroplasty versus total knee arthroplasty.

Proprioception was measured in 2 groups of patients after successful knee arthroplasty. Twenty-eight patients had total knee arthroplasty and their results were compared with an age matched group of 10 subjects who had undergone unicondylar knee arthroplasty. The threshold to detection of passive motion was quantified as a measure of proprioception. The degree of preoperative arthritis was objectively classified according to Resnick. The anterior cruciate ligament and posterior cruciate ligament were present and preserved in all the patients who had undergone unicondylar knee arthroplasty. The anterior cruciate ligament was sacrificed and posterior cruciate ligament retained in 15 of the patients who had total knee arthroplasty and the anterior cruciate ligament and posterior cruciate ligament were sacrificed in 13 of the patients who had total knee arthroplasties. There was no difference in threshold to detection of passive motion among any of the 3 groups. Maintaining the anterior cruciate ligament and posterior cruciate ligament did not impart improved proprioception in unicondylar knee arthroplasty nor did maintaining the posterior cruciate ligament impart improved proprioception in total knee arthroplasty.

Aged↗

PubMedDate not supplied

Reimplantation of a shoulder arthroplasty after a previous infected arthroplasty.

Currently, there is little information on the results of reimplantation after previous resection for an infected shoulder arthroplasty. The purpose of this study was to determine the rate of recurrent infection and clinical results. Between 1975 and 2000, 4 patients with a resection arthroplasty from a previously infected shoulder arthroplasty underwent subsequent reimplantation of a prosthesis. The time interval from resection arthroplasty to reimplantation ranged from 7 months to 5.5 years. The mean clinical follow-up was 7.4 years (range, 2-15 years). There were no patients with recurrent infection. At the most recent follow-up, 2 patients had no pain, 1 had slight pain, and 1 had moderate pain. Mean elevation improved from 60 degrees to 80 degrees, and external rotation improved from 13 degrees to 50 degrees. With regard to patient satisfaction, 1 patient was much better, 2 were better, and 1 was the same. There were 2 satisfactory results and 2 unsatisfactory results. Reimplantation of a shoulder arthroplasty after a previous resection arthroplasty for infection can be performed with a low risk of reinfection. However, arthroplasty in this setting is especially challenging because of the potential for significant bone and soft-tissue deficits. These challenges can compromise the clinical results.

Arthroplasty, Replacement↗

PubMed1993

Massive resection and prosthetic replacement for the treatment of metastases of the trochanteric and subtrochanteric femoral region bipolar arthroplasty versus total hip arthroplasty.

Twenty-eight metastases of the proximal femur were treated by resection and by prosthetic replacement using a large femoral component with diaphyseal support (megaprosthesis). When metastatic involvement of the acetabulum was not evident a mobile self-centering cup was used (bipolar hip arthroplasty: 17 cases). When metastatic destruction of the acetabulum was evident acetabular reconstruction was performed (total hip arthroplasty: 11 cases). Postoperative pain relief according to Habermann was excellent in 81.5% and good in 14.8% of the patients. The functional results according to Merle d'Aubigné were rated as excellent in 19%, very good in 22%, and good in 22% of the hips. The rate of postoperative dislocation was significantly lower (p < 0.05) in the bipolar arthroplasty group when compared to the total hip arthroplasty group. Our experience indicates that, when bone disease of the acetabulum is not evident, a bipolar arthroplasty rather than a total hip arthroplasty should be recommended. In the current series pain relief as well as postoperative walking ability were comparable in both groups but the dislocation rate was significantly lower with bipolar arthroplasty.

Acetabulum↗

PubMed2003

Total joint arthroplasty in the extremely elderly: hip and knee arthroplasty after entering the 89th year of life.

The goal of this study was to evaluate the complications and efficacy of total joint arthroplasty in the extremely elderly and compare the survival with the normal age-matched population. One hundred one joint arthroplasties (45 total knee arthroplasties [TKAs], 56 total hip arthroplasties [THAs]) were performed in 83 patients 89 years old and older. Over an average follow-up period of 2.5 years, 26 (31%) of the patients died. Three patients (3.6%) died within the first 2 months' postoperatively. The perioperative medical complication rate (excluding deaths) was 14%. Significant improvements were noted in pain scores, Harris Hip Scores, and Knee Society Scores. The survival of patients in their nineties who undergo total joint arthroplasty is at least equal to the survival of an age-matched population for 2.5 years following surgery. With careful patient selection and patient care to minimize medical complications, total joint arthroplasty can be an excellent option for patients who are age 89 and older.

Age Factors↗

PubMed2005

Operative treatment of deep chondral defects of the patella: results after abrasive arthroplasty and periosteal arthroplasty.

This prospective, non-randomized study was aimed to evaluate the effects of abrasive arthroplasty and periosteal arthroplasty in the treatment of deep chondral defects of the patella. A total of 30 patients in group A (13 male, 17 female, age: 28.7+/-6.9 years) underwent arthroscopic abrasive arthroplasty. The other patients in group B (n=17, 11 male, 8 female, age 26.8+/-7.0 years) underwent periosteal arthroplasty by an autologous periosteal flap. The maximal diameter of the defects was 31.1+/-6.7 (range 20-45 mm). The Lysholm score and the intensity of pain were evaluated preoperatively and at the time of follow-up (3.1+/-1.1, range 2-5 years). The Tegner activity score was evaluated before onset of the symptoms and at the time of follow-up. The Lysholm score increased significantly in both groups (in group a from 36.1+/-7.1 to 42.5+/-6.6 points and in group B from 42.7+/-2.4 to 67.6+/-7.8 points). The result in group B was significantly better than in group A. In group A the intensity of pain was unchanged, whereas patients from group B reported a significant reduction of pain. The level of physical activity (Tegner score) was 5.5+/-2.1 in group A and 5.5+/-2.1 in group B before onset of the complaints. In follow-up, patients from group B (4.9+/-1.2) had a reduced Tegner score in tendency. The patients in group A had a significantly reduced level of physical activity (2.7+/-0.6). A total of 12 patients from group B had a range of motion lesser than 80 degrees in flexion. These patients underwent joint mobilization and control arthroscopy. During control arthroscopy there was always found a stable periosteal flap. Short-term clinical results with periosteal arthroplasty produced a significant reduction in pain and improved Lysholm score in comparison to abrasive arthroplasty.

Adult↗

PubMed2006

[Clinical results of resection arthroplasty for infected shoulder arthroplasty].

PURPOSE OF THE STUDY: Infection is a rare complication of shoulder arthroplasty. Various therapeutic solutions have been proposed: antibiotics alone, one-stage or two-stage reimplantation, surgical or arthroscopic cleaning without prosthesis removal, scapulohumeral arthrodesis or simple arthroscopic resection. We evaluated the mid-term clinical outcome after resection arthroplasty for the treatment of infected shoulder arthroplasty. MATERIAL AND METHODS: The series included ten infected arthroplasties in ten patients. Mean duration of implantation was two years seven months (range nine months to five years). Bacteriological diagnosis was established from intraoperative articular samples or systematic samples taken during surgical revision procedures: meti-S Staphylococcus aureus strains (n=4), coagulase-negative Staphylococcus (n=5 including three S. epidermidis) Streptococcus mitis (n=1) and Citrobacter koseri (n=1). The mean Constant score before revision was 58 (range 23-77). Subjective patient satisfaction before surgical revision was rated good in six cases, fair in one and poor in three. Surgery associated removal of the implant, complete resection of the cement, resection of the fistular tracts, wide debridement of infected tissues and total synovectomy. RESULTS: Patients were seen at an average follow-up of three years eight months. The objective functional outcome measured with the Constant score was only fair, 28 points (range 20.6-36), and corresponded to a loss of 29 points compared with the preoperative score. This was explained mainly by lower scores for joint motion, function and muscle force but with persistently satisfactory scores for pain. All patients remained pain-free (daytime and nighttime). Patient satisfaction was rated good for two, fair for five and mediocre for three. Clinical and biological proof of eradicated infection was obtained in all patients. DISCUSSION: Infection remains a serious devastating problem for shoulder arthroplasty with an important functional impact. Resection only has a modest clinical effect. Precise identification of the causal germ with institution of adapted antibiotic therapy is required for eradication of the infection. Early diagnosis is probably the most important parameter affecting clinical outcome and surgical options. Functional results after resection arthroplasty are modest. This procedure should be reserved for patients with reduced functional demands. Improved management of the infectious load and reduction of diagnostic delay should help improve functional outcome and favor use of stow-stage procedures for reinsertion.

Aged↗

PubMedDate not supplied

Anatomical interposition arthroplasty with dermal graft. A study of 51 elbow arthroplasties on 48 rheumatoid patients.

Seventy anatomical interposition arthroplasties of the elbow joint without ulnar nerve transposition were performed on 67 rheumatoid patients by one surgeon during the years 1978-1984. Between 1 and 6 years after arthroplasty, 51 arthroplasties were re-examined, the average follow-up being 3 years. There were 48 patients, 44 female (aged 25 to 66 years, mean 51) and four male, (aged 59 to 69 years, mean 63). The duration of the rheumatoid disease (46 cases of rheumatoid arthritis, 2 of juvenile chronic arthritis) was 4 to 33 years, mean 17 years. The disease was clinically active in 47 cases. ESR ranged from 12 to 82, mean 50. 51 elbow joints, 32 right (31 dominant), 19 left (2 dominant), had been affected for six months to 29 years, mean 8 years. 21 joints had been operated on one to four times before arthroplasty. Preoperative radiological joint destruction was of Larsen grade IV in 45 cases and of grade V in six cases. Flexion contracture was diminished from preoperative 0 degrees to 70 degrees, mean 38 degrees, to postoperative 0 degrees to 70 degrees, mean 25 degrees. Range of flexion was improved from preoperative 20 degrees to 150 degrees, mean 90 degrees, to postoperative 40 degrees to 145 degrees, mean 109 degrees. Before arthroplasty there were ulnar nerve symptoms in 13 cases, two of which had temporary ulnar symptoms postoperatively, too. After arthroplasty, eight patients had ulnar nerve symptoms, five of which had had previous operations of the joint.

Adult↗

PubMedDate not supplied

Resection arthroplasty for nonseptic failure of total hip arthroplasty.

Although resection arthroplasty is a well-recognized salvage procedure for septic total hip arthroplasty, the nonseptic complications of total hip arthroplasty are customarily handled by revision and replacement of a new total hip implant. Some of the severe forms of failure of total hip arthroplasty in the absence of infection may require resection arthroplasty. The indication is massive loss of available bone stock for the revision operation. This may result from technical errors or progressive and extensive destruction of bone associated with loosened components. Concern for this outcome is important for assessing the probabilities of long-term success of the use of total hip arthroplasty in young patients.

Adult↗

PubMed1998

Simultaneous ipsilateral revision total hip arthroplasty and revision total knee arthroplasty with entire femoral allograft.

Treatment of periprosthetic fractures of both total hip arthroplasty and total knee arthroplasty has been well described in the literature. Treatments used have included closed treatment, revision arthroplasty with or without bone graft, open reduction internal fixation with plating, or intramedullary fixation [1-4]. However, treatment of periprosthetic fractures that involve a femur that has both a proximal total hip prosthesis and a distal total knee prosthesis has not been thoroughly described in the literature. We present a persistent distal femoral nonunion of a periprosthetic fracture, which was treated by using an entire femoral allograft with simultaneous ipsilateral revision total hip arthroplasty and total knee arthroplasty.

Arthroplasty, Replacement, Hip↗

PubMed2007

Gait analysis of patients with resurfacing hip arthroplasty compared with hip osteoarthritis and standard total hip arthroplasty.

Patients with standard total hip arthroplasties may have reduced hip abduction and extension moments when compared with normal nonosteoarthritic hips. In comparison, patients after resurfacing total hip arthroplasty appear to have a near-normal gait. The authors evaluated temporal-spatial parameters, hip kinematics, and kinetics in hip resurfacing patients compared with patients with unilateral osteoarthritic hips and unilateral standard total hip arthroplasties. Patients with resurfacing walked faster (average 1.26 m/s) and were comparable with normals. There were no significant differences in hip abductor and extensor moments of patients with resurfacing compared with patients in the standard hip arthroplasty group. This study showed more normal hip kinematics and functionality in resurfacing hip arthroplasty, which may be due to the large femoral head.

Adult↗

PubMed2000

Are the findings in the Swedish National Total Hip Arthroplasty Register valid? A comparison between the Swedish National Total Hip Arthroplasty Register, the National Discharge Register, and the National Death Register.

The Swedish National Total Hip Arthroplasty (THA) Register was initiated in 1979, and it is one of the oldest quality registers in the world. The register covers all hospitals in Sweden, and today it contains > 205,000 hip arthroplasties. The failure endpoint definition in the register is revision. There is no information about quality of life and mortality. The aim of this study was to validate the results presented by the Swedish THA register by comparison with the Discharge register (the Swedish National Board of Health and Welfare) and to study mortality after hip arthroplasties. All hip arthroplasties from the Discharge register, performed in 1986 and thereafter, were compared with the Swedish THA register. Epidemiologic parameters, including mortality, were documented from the Swedish Death register. The mortality for primary THAs for men was 1% higher and for women 6% higher when compared with an age-matched and sex-matched cohort. For revision, the numbers were 7% and 9% higher. The risk for death compared with an age-matched and sex-matched population was lower for patients with osteoarthrosis treated with hip arthroplasty. The results with revision as failure endpoint showed that the Swedish THA register is reliable. The register includes >95% of the primary and revision THAs performed in Sweden between 1986 and 1995.

Aged↗

PubMed1988

Keller arthroplasty in combination with resection arthroplasty of the lesser metatarsophalangeal joints in rheumatoid arthritis.

We reviewed the results of the Keller arthroplasty in combination with resection arthroplasty of the forefoot in patients with rheumatoid arthritis. Of the 29 patients (49 feet) in the series, 20 had involvement of both feet and nine had involvement of a single foot. The average age of the patients was 55.4 years, and the average follow-up period was 4.9 years. All feet had resection of the lesser metatarsal heads, resection of the base of the proximal phalanges of the lesser toe, and a Keller arthroplasty of the first metatarsophalangeal joint. The results were satisfactory in 16 feet, satisfactory with some reservations in 21 feet, satisfactory with major reservations in seven feet, and unsatisfactory in five feet. For 40 of the 49 feet (82%), the patients stated that they would repeat the procedure, knowing the results achieved. The major causes of patient reservations and lack of satisfaction were return of the hallux valgus deformity and pain (53%), forefoot instability (27%), and continuing metatarsalgia (20%). Resection arthroplasty of the lesser metatarsophalangeal joints of the forefoot in rheumatoid disease is a satisfactory procedure. When used in combination with Keller resection arthroplasty of the first metatarsophalangeal joint, however, an increased number of unsatisfactory results occur, attributable to returning pain and deformity of that joint.

Adult↗

PubMed2006

Removal of acetabular bone in resurfacing arthroplasty of the hip: a comparison with hybrid total hip arthroplasty.

Resurfacing arthroplasty of the hip is being performed more frequently in the United Kingdom. The majority of these patients are younger than 55 years of age, and in this group the key benefits include conservation of femoral bone stock and the potential reduction in the rate of dislocation afforded by the larger resurfacing head. Early aseptic loosening is well recognised in patients younger than 55 years of age, and proponents of resurfacing believe that the improved wear characteristics of the metal-on-metal bearing may improve the long-term survival of this implant. There has been some concern, however, that resurfacing may not be conservative of acetabular bone. We compared a series of 33 consecutive patients who had a hybrid total hip arthroplasty with an uncemented acetabular component and a cemented femoral implant, with 35 patients undergoing a Birmingham hip resurfacing arthroplasty. We compared the diameter of the implanted acetabulum in both groups and, because they were not directly comparable, we corrected for patient size by measuring the diameter of the contralateral femoral head. The data were analysed using unpaired t-tests and analysis of covariance. There was a significantly larger acetabulum in the Birmingham arthroplasty group (mean diameter 56.6 mm vs 52.0 mm; p < 0.001). However, this group had a significantly larger femoral head diameter on the contralateral side (p = 0.03). Analysis of covariance revealed a significant difference between the mean size of the acetabular component implanted in the two operations. The greatest difference in the size of acetabulum was in those patients with a larger diameter of the femoral head. This study shows that more bone is removed from the acetabulum in hip resurfacing than during hybrid total hip arthroplasty, a difference which is most marked in larger patients.

Acetabulum↗

PubMed1996

Conversion of failed modern unicompartmental arthroplasty to total knee arthroplasty.

Between January 1983 and January 1991, 29 patients (31 knees) with a failed Robert Brigham metal-backed knee arthroplasty (Johnson & Johnson, Raynham, MA) underwent revision to a total knee arthroplasty (TKA). Twenty-five patients had osteoarthritis, three avascular necrosis, and one rheumatoid arthritis. The average patient age was 72.3 years (range, 49-88 years), and the average weight was 179 lb. (range, 112-242 lb.). The interval between the primary and secondary index procedures averaged 62 months (range, 7-106 months), and mean postrevision follow-up period was 45 months (range, 24-104 months). The primary mechanism of failure of the UKA was tibial polyethylene wear in 21 knees and opposite compartment progression of arthritis in 10 knees. Sixteen knees had particulate synovitis with dense metallic staining of the synovium. At revision, the posterior cruciate ligament was spared in 30 knees and substituted in 1 knee. Restoration of bony deficiency at revision required cancellous bone-graft for contained defects in seven knees, tibial wedges in four knees, and femoral wedges in two knees. No defects received structural allografts. The data suggest that failed, modern unicompartmental knee arthroplasty can successfully be converted to TKA. In most cases, the posterior cruciate ligament can be spared and bone defects corrected with simple wedges or cancellous grafts. Moreover, the results of revision of failed unicompartmental knee arthroplasty are superior to those of failed TKA and failed high tibial osteotomy and comparable to the authors' results of primary TKA with similar-length follow-up periods. Although these results are encouraging, longer-term follow-up evaluation is required to determine survivorship of these revision arthroplasties.

Adult↗

PubMed1992

Long-term follow-up of a total articular resurfacing arthroplasty and a cup arthroplasty in Gaucher's disease.

Patients with Gaucher's disease, a well-described lipid storage disorder with many systemic manifestations, often present to the orthopaedic surgeon with osteonecrosis of the femoral head. This can be a difficult orthopaedic problem because of the patient's young age at presentation and abnormal bone stock. Review of the literature leaves uncertainty as to the ideal treatment of femoral-head avascular necrosis in this disease. This article reports the long-term results of a cup arthroplasty and a total articular resurfacing arthroplasty procedure for bilateral hip involvement. In light of the less-than-satisfactory results of total hip arthroplasty for young patients with Gaucher's disease, resurfacing arthroplasty may warrant more serious consideration. For the older patient with Gaucher's disease, total hip arthroplasty may be preferable.

Child↗

PubMed1990

A comparison between cemented and cementless implants in revision arthroplasty of the hip following resection arthroplasty.

Twenty patients underwent hip re-arthroplasty following resection arthroplasty due to former prosthetic infection, aseptic loosening, or TBC coxitis. In 9 cases Gentamycin-loaded cement was used. In 11 the re-arthroplasty was cementless. The overall results, evaluated by the Mayo and Harris scoring systems, were moderately good. Seventy-five per cent of patients reported relief from pain and improved hip function. However, in the previously infected cases significantly better results were found in the cementless group, while major complications such as deep infection, luxation, or loosening of the implant were mainly concentrated in the cementless re-arthroplasties following aseptic loosening and cemented re-arthroplasties following septic as well as aseptic failures.

Aged↗

PubMed1986

Resection arthroplasty: an alternative to arthrodesis for salvage of the infected total knee arthroplasty.

Arthrodesis remains the procedure of choice for salvage of an infected total knee arthroplasty in patients with relatively minor preprosthetic arthroplasty disability. Patients with very severe preprosthetic disability resulting from multiarticular disease or other systemic disease may be treated best by a resection arthroplasty. Systemic sepsis can be eliminated in almost all patients, and drainage can be eliminated in most. Those patients who find the stability of a resection arthroplasty inadequate for their needs can have a secondary arthrodesis performed with an intramedullary rod, which yields a high probability of success. External immobilization is not necessary. The advantages of a two-stage arthrodesis are that it is an elective procedure, performed in a limb free of sepsis. The patient has been psychologically prepared for the arthrodesis, and the two-stage procedure has a high probability of success. Neither the underlying diagnosis, nor the infecting organism, nor the type of infected prosthesis is a reliable predictor of success or failure of either a resection arthroplasty or a second-stage arthrodesis.

Aged↗

PubMed2000

Expression of keratan sulfate at the arthroplasty surface after cup arthroplasty.

Fibrous tissue which regenerated on the acetabular arthroplasty surface was obtained from a 52-year-old woman who underwent total hip replacement after cup arthroplasty. The histological features of this newly formed fibrous tissue and expression of keratan sulfate, which is a characteristic matrix component of articular cartilage, were studied. Microscopic observation revealed that the arthroplasty surface consisted mainly of fibrous tissue which did not show metachromasia with toluidine blue staining, but there were many nodular structures communicating with the bone marrow. Immunostaining for keratan sulfate revealed clear positive staining around the cells of the nodular structures communicating with the bone marrow, while only weakly positive staining was observed in the superficial layer of the loose fibrous tissue. The present study revealed marked formation of articular cartilaginous tissue in areas having good communication with the bone marrow, which indicates that maintenance of this communication may be necessary to improve the outcome of cup arthroplasty.

Arthroplasty, Replacement, Hip↗