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PubMed2002

Comparison of total hip arthroplasty performed with and without cement : a randomized trial.

BACKGROUND: This study was designed to compare the fixation of a Mallory-Head total hip prosthesis with and without cement. METHODS: Two hundred and fifty patients with osteoarthritis of the hip were randomized to receive a Mallory-Head total hip prosthesis designed for insertion with cement or the same prosthesis designed for insertion without cement. Neither the patient nor the outcomes assessor was aware of the type of prosthesis. Outcomes were assessed with respect to mortality, revision arthroplasty, health-related quality of life (evaluated with the Harris hip score, Merle d'Aubign and Postel hip score, McMaster-Toronto Arthritis Patient Preference Disability Questionnaire (MACTAR), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and the time trade-off technique), and the six-minute-walk test. Patients were seen at three, six, and twelve months and yearly thereafter. RESULTS: The prosthesis was inserted with cement in 124 patients and without cement in 126 patients. The mean age of the patients was sixty-four years, 48% were female, and the mean duration of follow-up was 6.3 years. There were thirteen revisions in the group that had fixation with cement and six in the group that had fixation without cement (p = 0.11), and more femoral components were revised in the group that had fixation with cement (twelve versus one; p = 0.002). All health-related quality-of-life measures improved postoperatively in both groups. CONCLUSIONS: In this randomized trial, the group that had the cemented Mallory-Head hip prostheses required more revisions of the femoral component than did the group with the cementless Mallory-Head prostheses, which was perhaps related to the titanium-alloy femoral stem. Our findings are specific to the implants evaluated in this study.

Aged↗
PubMed2004

Unicompartmental knee arthroplasty in patients sixty years of age or younger.

BACKGROUND: Unicompartmental knee arthroplasty has been used to treat elderly, low-demand patients, but the literature is sparse regarding the use of this procedure for younger, active patients. The purpose of the present retrospective study was to evaluate the results of unicompartmental knee arthroplasty in younger, more active patients. METHODS: Forty-one patients underwent forty-six consecutive unicompartmental knee arthroplasties with use of the Miller-Galante system between 1988 and 1996. All of the patients were sixty years of age or younger and all were physically active. The Hospital for Special Surgery knee score and the University of California at Los Angeles activity assessment were used to rate the function and to determine the activity level of each patient, respectively. Serial radiographs were used to evaluate the status of prosthetic fixation, femorotibial alignment, and the progression of arthrosis in the unreplaced compartment. Long-term survivorship was calculated with use of Kaplan-Meier analysis. RESULTS: The mean duration of follow-up was eleven years. Of the forty-five knees that were available for follow-up, three had been revised. The Hospital for Special Surgery score was excellent for thirty-nine (93%) of the remaining forty-two knees and good for three. The University of California at Los Angeles activity assessment score was 6.6 +/- 1.4 for the knees in which the original prosthesis had been retained and 7.3 +/- 1.5 for those in which it had been revised. Two asymptomatic patients had revision of a modular tibial component because of substantial radiographic evidence of polyethylene wear; one of these patients had exchange of the polyethylene insert and the tibial tray, and the other had exchange of the polyethylene insert only. A third patient underwent revision total knee arthroplasty because of continuing knee pain and a progressive tibial radiolucent line that was >2 mm in width. The average postoperative femorotibial alignment was 5 degrees of valgus. Nine knees had progression of arthritis in the unresurfaced compartment; none of these knees were revised, and none of the patients had deterioration in the Hospital for Special Surgery score. Kaplan-Meier analysis demonstrated an eleven-year survivorship of 92%. CONCLUSIONS: At an average duration of follow-up of eleven years, unicompartmental knee arthroplasty was associated with pain relief and excellent function in a cohort of patients who had been sixty years of age or younger and active at the time of surgery.

Arthroplasty, Replacement, Knee↗
PubMed2002

Using three-dimensional rotational angiography for sizing of covered stents.

OBJECTIVE: The purpose of our study was to determine the value of three-dimensional (3D) rotational angiography in the assessment of patients to be treated with covered stents for peripheral arterial aneurysms. CONCLUSION: Our preliminary experience suggests that 3D rotational angiography appears to be a valid tool in the pre- and perprocedural assessment of patients treated endovascularly for arterial aneurysms.

Aged↗
PubMedDate not supplied

[Effect of primary and secondary below-knee amputation of war injuries on the length of hospitalization and rehabilitation].

The results of below-knee amputations in 36 war wounded (mean age 35.42) were reviewed. The majority of the patients was wounded by land mines (94.4%). Most of them were between 25 and 35 years old. Bilateral amputation was done in 2.8% of cases. The amputation was performed on the day of wounding (primary below-knee amputation) in 30 (83.3%) amputees. Secondary amputation after the attempt to save the severely injured lower-limb was performed in 6 patients (16.7%) average 4.61 +/- 11.67 days after wounding. Reamputation was necessary in 6 cases (16.7%). Time period from the beginning of rehabilitation to the fitting of prosthesis, was 36.25 +/- 14.97 days for primary amputations, 32 +/- 17.8 days for secondary amputations and 68.66 +/- 33.52 days for reamputations. There was no significant correlation between the duration of rehabilitation to prosthetic management and the period between wounding and amputation (r = -0.102). The attempt to save the limb after severe below-knee injuries and the secondary amputation afterwards, did not significantly influence the ensuing rehabilitation and prosthetic works.

Adult↗
PubMed1996

Axial wall convergence of full veneer crown preparations. Documented for dental students and general practitioners.

The convergence angle in 478 full crown preparations was assessed. Of these preparations, 351 had been performed by general practitioners and 127 by dental students. Groups of preparations performed on incisors, premolars, and molars were compared, as were preparations performed by dentists and students. Two different convergence angles were measured for each tooth, buccolingually and mesiodistally. The results showed a mean angle of 21 degrees. The mean values for premolars and molars differed significantly. When a comparison was made of preparations performed by students, a significant difference was found between premolars and molars. The same comparison for general practitioners showed a significant difference both for incisors compared with molars and for premolars compared with molars. A wide range was found for the convergence of the axial walls, especially for the preparations performed by general practitioners.

Clinical Competence↗
PubMedDate not supplied

The relationship between the uncomfortable loudness level and the acoustic reflex threshold for pure tones in normally-hearing and impaired listeners--a meta-analysis.

The objective of this study was to determine the potential of the acoustic reflex threshold (ART) as a predictor of the uncomfortable level (ULL) and to identify related areas for investigations in the future. Eleven studies reporting data from 141 normally-hearing and 240 impaired hearing subjects have been reviewed, focusing on methods, test conditions and subjects. Results and conclusions are discussed and new calculations have been performed on the reported data. The median difference between ART and ULL across studies and frequencies was 5 dB both in normally-hearing and impaired subjects. Some authors argue, that although a close relationship of mean values of the two measurements may exist, prediction of the ULL based on ART measurement will be inaccurate because of high inter-subject variability. A statistically significant correlation exists between the mean HTL, the mean ART and the mean ULL in impaired hearing, while a relationship between the mean ART and the mean ULL does not exist in normal hearing. Based on pooled data across frequencies from the reviewed studies the mean ULL= (0.64 x mean ART+38) dB HL. The discrepancies between the results found in the reviewed studies may be explained by different instructions and stimulus presentation orders when assessing the ULL, difficulty in assessing the sound pressure level in the ear canal, influence of varying background noise levels and different admission criteria. It is recommended that the relationship between different loudness levels and the ART be investigated in normally-hearing subjects and in subjects with different levels of impairment, using standardized instructions. To further provide uniformity of the test material groups should be selected according to history of middle ear diseases and the use of hearing aids.

Adolescent↗
PubMed1997

Technical and audiological factors in the implementation and use of digital signal processing hearing aids.

Fully digital hearing aids, to be worn behind or within the ear, are coming on to the market. The new possibilities and challenges of such aids are both technological and audiological in character. This paper describes some of the challenges, and one manufacturer's approach to them. The signal processing structure in one current digital hearing aid is presented, and justified in audiological terms, as a background to discussions of (i) the relative urgency of further advances in technology and audiological knowledge, and (ii) the challenges to the practice of hearing aid dispensing. It is concluded that further advances in rehabilitative audiology are more pressing than further major technological progress, and that the potential client benefits of the new generation of digital hearing aids will only be realized if the challenges they present to software design and dispensing practice are recognized and met.

Correction of Hearing Impairment↗
PubMed1997

The effects of involvement of the general practitioner and guidance of the hearing impaired on hearing-aid use.

A number of international and national publications report that hearing aids are sometimes under used. In this paper, results are reported of a project to increase the effective use of hearing aids. The first intervention was aimed at a more effective exchange of information between the general practitioner (GP) and the ENT specialist. This was achieved by the introduction of a structured referral form. In addition, a simple hearing aid was placed at the GP's disposal for demonstration purposes. As a second, independent intervention, 50% of the patients were visited at home by a trained volunteer. A measure of effective use that combines the effectiveness and actual use had been developed. After the first intervention the non-effective use of hearing aids decreased from 38% to 30%, this being just below statistical significance (p = 0.12). The protocol approach by the GP in combination with the demonstration hearing aid proved to be especially useful. Patients with a counselling visit at home had a significantly lower level of non-effective use (27% versus 37%; p < 0.05) than patients who had not been visited.

Age Factors↗
PubMed1996

The time course of adaptation to hearing aid use.

Adaptation to use of a hearing aid will depend on many factors, such as the degree of the loss, the age and personality of the individual, the duration of the loss, the performance of the aid, and the advice given by the audiologist/dispenser. This study investigated the use made of hearing aids by monitoring battery consumption over a one year period commencing at the first provision of amplification. A further investigation into use was made 10 years after the initial issue. Patterns of use over the first year were investigated and related, where possible, to the level of use 10 years later. About one-third of the subjects made little or no use of the behind-the-ear hearing aid provided free of direct cost through the National Health Service over the first year. A small proportion, primarily younger subjects, later increased their use of personal amplification to substantial levels. The majority, who tended to be at the upper end of the age range, did not. A similar proportion (one-third) started with limited use and progressed during the initial period of monitoring to more extended use. In some individuals the rate of progress was gradual. In others the transition from low to high use took place over a short period of time but after an interval ranging from a few weeks to many months. About one-sixth of the group used the aid extensively from the beginning and continued at this use level through to the long-term review. The final sixth, who tended to be towards the upper end of the age range, made only minimal use of their aids. Short-term (less than 6 months) assessment of use may, in the case of good users, be regarded as a measure of success, but if use is low at that time the long-term outcome may depend substantially on the age of the hearing aid user.

Adult↗
PubMed2004

The Northern Ireland troubles and limb loss: a retrospective study.

The Troubles in Northern Ireland have now lasted 34 years. Divisions and strife between the opposing loyalist and republican communities, and between the communities and the security forces, have led to thousands of deaths and injuries. The violence has often been indiscriminate injuring and killing totally innocent people. Staff at the Regional Disablement Services at Musgrave Park Hospital, Belfast have had the responsibility for helping to rehabilitate those who have suffered limb loss, both civilians and security forces personnel. In this study the authors present patient demographics for those survivors, referred for prosthetic fitting, who have sustained limb amputations as a result of the Troubles from 1969 to 2003, with the cause of injury, resulting levels of amputation, associated injuries, time to first prosthetic fitting and reason for any delay in fitting identified. One hundred and twenty-nine (129) patients sustained amputations, 110 male and 19 female with an age range at the time of injury from 7 to 60 years. Seventy-two (72) were civilian. Ninety-three (93) underwent immediate amputation, the most frequent level of amputation being trans-femoral. Delayed healing of deep wounds was the most common reason for delayed amputation; other causes were chronic osteomyelitis, malunited fractures and failed arthrodesis, often associated with chronic pain. Ninety-two (92) patients required amputation of one limb or part thereof, 35 required amputation of 2 limbs and 2 underwent triple amputation. Three (3) patients lost both hands. Sixty seven percent (67%) had other associated physical injuries. Thirty-two (32) patients had a delay of 6 months or more in fitting a prosthesis. The most common cause of injury was the car bomb.

Adolescent↗
PubMed1978

Problems in the rehabilitation of the physically disabled in rural areas of India.

Some 550 disabled patients were examined by a rehabilitation team by organizing a rural camp at Meerut. This rehabilitation team consisted of orthopaedic surgeons, doctors, a prosthetist, an orthotist, a medical social worker and other skilled workers. Out of the 550 disabled patients, 271 were amputees, and 184 cases had poliomyelitis. Males predominated by 4:1. Disability was most common up to the age of 30 years. Of the 271 amputees, 146 were of upper limb while 125 were of lower limb. Only 86 lower limb amputees were suitable for fitting a prosthesis, while 39 others needed surgery of physiotherapy. Only 87 of the 184 polio cases were found suitable for appliances, the remainder needing surgery or physiotherapy. Ways of reducing the numbers of disabled were examined and improved rehabilitation procedures suggested.

Adolescent↗
PubMed1996

Influence of speed on gait parameters and on symmetry in trans-tibial amputees.

Normal gait is characterised by a high level of inter-leg symmetry of gait parameters. Therefore, efforts in rehabilitation of amputees are directed at the construction of a prosthesis which provides normal leg function and allows a more symmetrical gait. Analysis of the gait of trans-tibial amputees was performed when they were ambulating at their own freely selected speed and at a faster speed. The effect of speed on selected gait parameters in each leg was evaluated and the influence on symmetry established by comparing the inter-leg changes for each of the selected parameters. The faster gait trail affected significantly all temporal and distance parameters in both legs but not the level of symmetry between legs. At the faster speed, the hip angles at heel-strike and during swing and the knee angle during load response, in the normal leg, and the knee angle during swing in the amputated leg, all increased significantly. Speed of gait significantly affected symmetry between knee angles as reflected by the increased differences measured during load response (from 2.62 +/- 5.2 to 7.06 +/- 4.2 degrees) and during toe-off (from 1.80 +/- 7.4 to 9.50 +/- 9.1 degrees). Timing and sequence of selected gait events, as related to stride time, were not significantly affected by speed of gait. These results might contribute to a better understanding of gait characteristics in trans-tibial amputees and provide design guidance for prosthetic components.

Adult↗
PubMed1996

Painful neuromata following upper limb amputation.

Painful neuromata occurring after upper limb amputation are a significant cause of stump pain and limit the success of prosthetic training and use. There is little information in the literature regarding incidence, consequences or outcomes of painful neuromata subsequent to upper limb amputation. This article reports an analysis of thirty-two consecutive upper limb amputees. Of these 25% had moderate-to-severe stump pain and clinical signs suggestive of neuromata. All patients with neuromata were limited in their ability to use a prosthesis prior to surgery and following failure of conservative measures, were referred for surgical opinion. Six patients have undergone surgical management. The results of surgery, with respect to pain and prosthetic usage, are discussed.

Adolescent↗
PubMed1997

Suspension effect and dynamic evaluation of the total surface bearing (TSB) trans-tibial prosthesis: a comparison with the patellar tendon bearing (PTB) trans-tibial prosthesis.

X-ray and cineradiography measurements were used to compare the suspension effect and stability of a TSB trans-tibial prosthesis with an Icelandic Roll-On Silicone Socket (ICEROSS) system to that of a PTB trans-tibial prosthesis. The suspension effect was measured by the distance between the tibia and the socket in both suspension position and weight-bearing position in both type of prostheses. The suspension effect of the TSB prosthesis (2.53 +/- 0.90 cm) was superior to that of the PTB prosthesis (3.60 +/- 0.56 cm) (p < 0.05) by x-ray measurement. The suspension effect of the TSB prosthesis (0.1, 0.4, 0.72 cm) was superior to that of the PTB prosthesis (0.3, 0.48, 1.03 cm) (p < 0.01, p < 0.05) by cineradiographic measurement. The stability was measured as the angle between the axis of the tibia and the prosthesis at the time of heel contact and toe off. The angle change of the TSB prosthesis was statistically smaller than that of the PTB prosthesis.

Adult↗