1
|
|
2
|
Dahmen G, Dost G. [On the lateral load capacity of interphalangeal joint endoprostheses of the models according to St. Georg and Englert (author's transl)]. Z Orthop Ihre Grenzgeb 2008; 118:116-21. [PMID: 7424096 DOI: 10.1055/s-2008-1051479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
|
3
|
Abstract
Ultra high molecular weight polyethylene (UHMWPE) wear particles are frequently implicated in causing failure of total joint arthroplasties by eliciting a foreign body reaction. The majority of these particles are subcellular and many are submicron in size. Identification of these small particles of UHMWPE by conventional histologic techniques is difficult. We have therefore investigated the utility of Oil Red O (ORO) stain to identify UHMWPE on histologic sections. A wide variety of specimens was studied including an experimental rabbit model with subcutaneous implantation of polyethylene particles as well as specimens from clinical cases with joint arthroplasties. The sensitivity and specificity of ORO stain was compared to conventional polarized light microscopy for the identification of particulate UHMWPE debris. The ORO stain was found to be as sensitive in identifying particulate UHMWPE debris as polarized light microscopy. However, ORO stain was less specific: two specimens did not contain any UHMWPE also stained with ORO. Careful examination of standard hematoxylin and eosin stained sections with polarized light was therefore more specific for the identification of particulate UHMWPE. As a single test, the ORO stain does not appear to offer any clear advantage specifically for the identification of UHMWPE.
Collapse
Affiliation(s)
- T P Schmalzried
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | | | | | | |
Collapse
|
4
|
Abstract
Traumatic boutonniere deformity may become fixed and cannot be reduced when the joint cartilage become altered. We propose a resection arthroplasty with a Swanson's silicone implant as a valuable solution for this problem as it simplifies the joint and the extensor apparatus. We use a transverse approach through the extensor tendon which enables to restore a good balance between bone and tendon and seems to avoid some adhesions. Results of 17 operations with a minimum follow up of 12 months show that 40 degrees of motion have been recovered in an angle sector which corrects the deformity. The final evaluation is good if compared to the severity of the initial status.
Collapse
Affiliation(s)
- F Iselin
- Unité de Chirurgie de la Main et Urgence Main Nanterre, Hôpital de la Maison de Nanterre, France
| | | |
Collapse
|
5
|
Swanson AB, de Groot Swanson G, Ishikawa H. Use of grommets for flexible implant resection arthroplasty of the metacarpophalangeal joint. Clin Orthop Relat Res 1997:22-33. [PMID: 9308520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
In 1987, after 11 years of research, press fit titanium circumferential grommets were introduced for arthroplasty of the metacarpophalangeal joint to protect the flexible hinge implant midsection from sharp bony edges and shearing forces that can initiate implant abrasions and tears leading to implant fracture and formation of silicone wear particles. The effectiveness of the titanium circumferential grommets was assessed by comparing the results of 170 metacarpophalangeal joint implant (high performance) arthroplasties performed with (139 joints) and without (31 joints) grommets in 38 patients presenting an average 5.8 years followup. Both groups obtained pain relief, functional motion, stability, and correction of deformity. There was no evidence of particulate synovitis or infection. There were four implant fractures (12.9%) in the nongrommet group, and one (0.7%), because of implant rotation, in the grommet group. Although favorable bone remodeling was observed in both groups, the grommet group showed greater bone preservation at the metaphyseal and midshaft levels and increased intramedullary bone production around the implant stems. The results depend on appropriate surgical staging, meticulous operative and postoperative techniques, severity and progression of disease, and implant durability. The circumferential grommets safely and effectively protect the implant to bone interface to further the durability of implant arthroplasty of the metacarpophalangeal joint.
Collapse
Affiliation(s)
- A B Swanson
- Orthopaedic Research Department, Blodgett Memorial Medical Center, Grand Rapids, MI, USA
| | | | | |
Collapse
|
6
|
Abstract
Surgical treatment of OA is appropriate when conservative therapy fails or is inadequate. The veterinary orthopedist's goals in treatment should be to alleviate pain, maintain function, and prevent or remove the potential for further degeneration of the joint. Currently, in veterinary surgery, THR and femoral head and neck excision are the primary treatments for OA of the coxofemoral joint. Other joints are treated primarily by arthrodesis or excision arthroplasty. Arthroscopy is proving to be a valuable tool in the diagnosis and treatment of OA, and total stifle and elbow replacement and cartilage resurfacing through chondrocyte grafting are on the horizon as potential treatment options.
Collapse
Affiliation(s)
- J L Cook
- Department of Veterinary Medicine and Surgery, University of Missouri-Columbia Veterinary Medical Teaching Hospital, USA
| | | |
Collapse
|
7
|
Risung F. The Norway elbow replacement. Design, technique and results after nine years. J Bone Joint Surg Br 1997; 79:394-402. [PMID: 9180317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The Norway elbow prosthesis is a non-constrained cemented total replacement. It depends on intact collateral ligaments for stability, and allows a full range of movement. The system includes several sizes of components, all freely interchangeable, and semi-constraint can be provided by a locking ring if damaged collateral ligaments make dislocation possible. The prosthesis has been used in more than 350 elbows in Norway and the detailed results for 118 elbows studied prospectively since 1987 are reported. It is inserted through a posterolateral triceps-splitting incision with minimal muscle disruption and bone resection, preserving the collateral ligaments. The results as regards pain relief and range of movement were comparable with those of other elbow prostheses, but there were fewer serious complications. At a mean follow-up of 4.3 years, the failure rate was 3.4%.
Collapse
Affiliation(s)
- F Risung
- Department for Rheuma-surgery, Betanien Hospital, Skien, Norway
| |
Collapse
|
8
|
Abstract
Massive and irreparable loss of rotator cuff tendon integrity can be associated with the development of glenohumeral and acromiohumeral arthritis. Loss of glenohumeral instability provided by the rotator cuff may initiate and perpetuate this unique condition of the shoulder. Proximal humeral replacement arthroplasty is the preferred surgical treatment; special techniques of this procedure are presented. Patients are gratified by the durable restoration of comfort and, to a lesser extent, function.
Collapse
Affiliation(s)
- D N Collins
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | | |
Collapse
|
9
|
Andreassen G, Solheim LF. [Follow-up of Souter elbow prostheses]. Tidsskr Nor Laegeforen 1997; 117:940-2. [PMID: 9103003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
27 patients (30 elbows) treated with Souter elbow prosthesis replacement were examined at a follow-up study. 26 patients had rheumatic arthritis. The mean observation time was five years (2-10 years). The indication for surgery was severe pain and reduced elbow function. Preoperative radiological examination revealed considerable pathological changes in all the elbows. Six of the elbows underwent revision with new prosthesis replacement. The indications for the re-operations were fractures, loosening of the prosthesis and luxations. 19 elbows (26%) had deteriorated and three patients had no definite opinion. Four of the six elbows replaced by a new prosthesis, became worse than before the first operation. Follow-up radiological examination showed that 80% of the humerus components showed varying degrees of radiological loosening and more than half of the humerus components showed cranial migration. All patients who suffered fractures during the operation have been, or will be, re-operated. Radiological loosening of the prosthesis makes the prognosis uncertain for the majority of the patients. Re-operation with a new prosthesis is unsatisfactory. As a consequence of the poor results, this prosthesis is no longer used at our hospital.
Collapse
|
10
|
Faber KJ, Cordy ME, Milne AD, Chess DG, King GJ, Johnson JA. Advanced cement technique improves fixation in elbow arthroplasty. Clin Orthop Relat Res 1997:150-6. [PMID: 9005908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
An in vitro study was conducted to assess the efficacy of advanced cementing techniques in the fixation of the humeral stem in elbow arthroplasty. Sixteen fresh frozen cadaveric distal humeri were prepared to accept an acrylic sham humeral stem. Conventional cementing technique using doughy cement manually inserted and packed was performed in 8 specimens. The advanced cementing technique, consisting of canal irrigation, brushing and drying with gauze, canal plugging, and low viscosity cement pressurization with a delivery system was performed in the other specimens. All humeri subsequently were sectioned into 10 mm thick sections, photographed, and digitized to quantify the perimeter and area of the stem, cement mantle, corticocancellous junction, and cement voids. The degree of cement filling, determined from the area fraction of cement to the total available area within the corticocancellous junction, was significantly greater in the advanced group compared with the conventional group. Mechanical assessment of the specimens consisted of a push out load to failure test of the cement mantle from bone. For all locations in the distal humerus, the failure load and failure stress in the advanced group was significantly greater than the conventional group. It is concluded that development of an effective cement restrictor and application of advanced cement techniques in vivo should improve the initial fixation of the humeral component and may decrease the incidence of aseptic loosening associated with elbow arthroplasty.
Collapse
Affiliation(s)
- K J Faber
- Musculoskeletal Research Laboratory, The Lawson Research Institute, Hand and Upper Limb Center, St. Joseph's Health Centre, The University of Western Ontario, London, Canada
| | | | | | | | | | | |
Collapse
|
11
|
Abstract
Sixteen patients underwent hemiarthroplasty for rotator cuff arthropathy between June 1989 and March 1992, and evaluations obtained before and after surgery in all patients were compared. A modular head large enough to articulate with the coracoacromial arch but not so large as to prevent approximately 50% of humeral head translation on the glenoid was used in these cases. Each patient was evaluated with Neer's limited goals rating scale after an average follow-up of 33 months (24 to 55 months). Ten patients were rated as successful and six as unsuccessful. Four of the six unsuccessful patients had undergone at least one attempt at rotator cuff repair with acromioplasty before the index procedure, and two of these four patients had deficient deltoid function after this rotator cuff surgery as a result of postoperative deltoid detachment. Also, three of these four patients who had previously undergone acromioplasty subsequently had anterosuperior subluxation after hemiarthroplasty. Hemiarthroplasty did not provide for a successful outcome in all patients with rotator cuff arthropathy. However, 10 of the 12 patients in this series with good deltoid function and an adequate coracoacromial arch were rated as successful by Neer's limited goals criteria. In addition, this study illustrates that formal acromioplasty carried out during attempts at rotator cuff repair in such patients may jeopardize the subsequent success of hemiarthroplasty.
Collapse
Affiliation(s)
- L D Field
- Upper Extremity Service, Mississippi Sports Medicine Center, Jackson 39202, USA
| | | | | | | |
Collapse
|
12
|
Zamudio L, Gil-Orbezo F, Hernandez-Mercado G. An acrylic Judet hip prosthesis in a shoulder hemiarthroplasty for thirty-nine years--a case report. Int Orthop 1997; 21:91-2. [PMID: 9195260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We describe a hemiarthroplasty of the shoulder with an acrylic Judet hip prosthesis, inserted after the excision of a giant cell tumour of the head of the humerus, which functioned well for 39 years.
Collapse
Affiliation(s)
- L Zamudio
- Hospital Fundacion Conde de Valenciana, Mexico City, Mexico
| | | | | |
Collapse
|
13
|
Affiliation(s)
- M L Ramsey
- Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Jefferson Medical College, Philadelphia, PA, USA
| | | |
Collapse
|
14
|
Stolk PW, de Waal Malefijt MC, Buma P, Barneveld A. Total replacement of the metatarsophalangeal joint in the horse. A single pilot study. Vet Q 1996; 18 Suppl 2:S90-3. [PMID: 8933682 DOI: 10.1080/01652176.1996.9694701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
In this paper the successful replacement of an equine metatarsophalangeal joint by a human total condylar knee prosthesis is reported. In the period of observation following implantation of the endoprosthesis the experimental animal showed almost no lameness when exercised at walk, bearing weight on the operated limb. Flexion and extension of the joint were markedly reduced. The clinical and histological observations clearly support further investigation into the equine metatarsophalangeal joint replacement by an endoprosthesis.
Collapse
Affiliation(s)
- P W Stolk
- Department of General and Large Animal Surgery, Faculty of Veterinary Medicine, Utrecht University, The Netherlands
| | | | | | | |
Collapse
|
15
|
James WC, Friedman RJ. Total shoulder arthroplasty. J S C Med Assoc 1996; 92:426-31. [PMID: 8990669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- W C James
- Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston 29425, USA
| | | |
Collapse
|
16
|
Simonian PT, Green TM. Spontaneous resolution of soft-tissue interposition after closed reduction of hip endoprosthesis dislocation. Am J Orthop (Belle Mead NJ) 1996; 25:642-644. [PMID: 8886205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Over a 5-year period at a single institution, 164 endoprostheses were used for the treatment of displaced femoral neck fractures. Soft-tissue restraint preservation and repair (hip capsule and labrum) is recommended to enhance stability after endoprosthesis placement. When dislocation does occur, however, this soft tissue may become interposed after closed reduction. This occurred in 2 of the dislocations reported here. In these 2 dislocations, despite the widened joint space, the range of motion was stable. Neither of these cases had a subsequent dislocation, and after 1 month, both had spontaneously narrowed their joint space back to the immediate postoperative state.
Collapse
Affiliation(s)
- P T Simonian
- Department of Orthopedic Surgery, University of Washington School of Medicine, Seattle, USA
| | | |
Collapse
|
17
|
Abstract
Thirty-eight consecutive Neer II total shoulder arthroplasties were performed in 35 patients by one surgeon using the so called modem cement technique and followed for a mean of 5 years (range, 2-9.5 years). The preoperative diagnosis was osteoarthritis or avascular necrosis in 22 shoulders, rheumatoid arthritis in 10 shoulders, and posttraumatic arthritis in 6 shoulders. The components were implanted using specific improved techniques for cement fixation initially described for total hip arthroplasty. Twenty-six metal-backed and 12 polyethylene glenoid components were used. The humeral component was implanted with cement in 32 shoulders. There were no intraoperative fractures or postoperative neurapraxias. At most recent followup, 36 shoulders had no or slight pain with activity. The mean increase in active forward elevation was 38 degrees and in active external rotation was 29 degrees. There have been no revisions, and all components remain in place. With failure defined as definite radiographic loosening of the components, there was 97% survivorship at 5 years, and 93% at 8 years. Radiolucent lines around more than 50% of the bone cement interface of the humeral component were present in only 3 shoulders. Radiolucent lines around more than 50% of the bone cement interface of the glenoid component were seen in only 2 shoulders. Both components in 1 severely osteopenic shoulder had a complete radiolucent line and a change in position. Meticulous attention to cement technique may improve the long term survival of cemented total shoulder arthroplasty components.
Collapse
Affiliation(s)
- B L Norris
- UNC Hospitals, Division of Orthopaedic Surgery, University of North Carolina-Chapel Hill, 27599-7055, USA
| | | |
Collapse
|
18
|
Judet T, Garreau de Loubresse C, Piriou P, Charnley G. A floating prosthesis for radial-head fractures. J Bone Joint Surg Br 1996; 78:244-9. [PMID: 8666635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We report our experience over seven years with a floating radial-head prosthesis for acute fractures of the radial head and the complications which may result from such injury. The prosthesis has an integrated articulation which allows change of position during movement of the elbow. We present the results in 12 patients with a minimum follow-up of two years. Five prostheses had been implanted shortly after injury with an average follow-up of 49 months and seven for the treatment of sequelae with an average follow-up of 43 months. All prostheses have performed well with an improved functional score (modified from Broberg and Morrey 1986). We have not experienced any of the complications previously reported with silicone radial-head replacement. Our initial results suggest that the prosthesis may be suitable for the early or delayed treatment of Mason type-III fractures and more complex injuries involving the radial head.
Collapse
Affiliation(s)
- T Judet
- Service d'Orthopédie et Traumatologie, l'Hôpital Tenon, Paris, France
| | | | | | | |
Collapse
|
19
|
Abstract
Articulated total wrist arthroplasties have been used in the United States since 1974. In the 1980s the CFV wrist was developed in an attempt to reduce the incidence of imbalance, loosening, and bone resorption that has been seen in the early implants, and also to eliminate the use of bone cement. Since 1988, we have implanted 15 of these wrists. To date, nine patients are satisfied because of pain relief and motion; however, there have been 6 failures: 2 for infection, 3 because of a loose distal component, and 1 because of balance. Other problems that have been observed are flexor tenosynovitis, carpal tunnel syndrome, and a balancing problem.
Collapse
|
20
|
Nicholson GP, Misamore GW. Rotator cuff insufficiency in the arthritic shoulder: treatment alternatives. Semin Arthroplasty 1995; 6:273-9. [PMID: 10163531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Shoulder arthroplasty can relieve the pain and improve the functional status of an arthritic shoulder. Because of the unique anatomic characteristics of the glenohumeral joint, the rotator cuff provides stability and control of shoulder motion. Thus, an intact, functioning rotator cuff is necessary for successful shoulder arthroplasty. There are clinical situations where the rotator cuff is torn, absent, or incompetent and an arthritic condition affects the shoulder. The patient must understand that, when confronted with rotator cuff insufficiency and shoulder arthritis, the goal of surgical treatment is limited to pain relief, with shoulder function often limited by the condition of the rotator cuff. We will discuss the incidence of rotator cuff disease associated with differing arthritic conditions, the treatment options available, and expected outcomes in these difficult and challenging clinical situations.
Collapse
Affiliation(s)
- G P Nicholson
- Department of Orthopaedics, Indiana University, Indianapolis, 46202, USA
| | | |
Collapse
|
21
|
Romeo AA. Total shoulder arthoplasty: pearls and pitfalls in surgical technique. Semin Arthroplasty 1995; 6:265-72. [PMID: 10163530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Total should arthroplasty is recommended for the treatment of shoulder arthritis that causes severe pain and loss of function. Successful shoulder arthroplasty is a technically demanding procedure because of lack of intrinsic stability of the glenohumeral joint. The tension of the rotator cuff and glenohumeral capsule must be balanced for mobility and stability. Attention to important anatomic landmarks and glenohumeral relationships ("pearls") minimizes the risk of complications ("pitfalls").
Collapse
Affiliation(s)
- A A Romeo
- Department of Orthopaedics, Rush Medical College, Chicago, IL, 60612, USA.
| |
Collapse
|
22
|
Abstract
Forty cases of hallux rigidus treated by Silastic hemiarthroplasty over an average period of 110 months have been reviewed here. As many as 36% (14 feet) of the patients were unhappy with the results of their operation. Six implants had to be removed because of increasing pain and fragmentation of the prosthesis. These patients improved after the prosthesis was removed. It is concluded that Silastic hemiarthroplasty does not give an acceptable level of good results when compared with published reports of other forms of treatment. The probable causes of the high dissatisfaction rate are discussed.
Collapse
Affiliation(s)
- N S Shankar
- Department of Orthopaedics, Queen Elizabeth Hospital, Gateshead, Tyne & Wear, United Kingdom
| |
Collapse
|
23
|
Schwyzer HK, Simmen BR, Gschwend N. [Infection following shoulder and elbow arthroplasty. Diagnosis and therapy]. Orthopade 1995; 24:367-75. [PMID: 7478498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The rate of infection reported in recent publications is 0.8% after shoulder arthroplasty and ten times higher (8.1%) after elbow arthroplasty. The figures for shoulder arthroplasty correspond well with our own rate of revision for infection of 0.5% after 363 primary shoulder replacements. However, our average rate of revision for infection (1.8%) after 278 GSB-III elbow arthroplasties was considerably lower and included rheumatoid as well as post-traumatic indications. Our experience concerning etiologic factors, nature, diagnosis, treatment options, and long-term consequences of superficial and deep infections after shoulder and elbow arthroplasty are discussed for each joint separately and in relation to the literature.
Collapse
|
24
|
Abstract
From 1981 to 1985 28 ankle arthroplasties were performed using a congruent and cylindrical ankle design. The talus component was an anatomically shaped cap to cover the talus dome and the facets. The tibial component was congruent toward the talus and had two parallel bars on the back for fixation into the distal tibia. The diagnosis was osteoarthritis in 15 cases and rheumatoid arthritis in 11 cases (two bilateral cases). There were seven failures, giving a cumulative estimated survival rate of 70% for the prosthesis at 12 years.
Collapse
Affiliation(s)
- H Kofoed
- Department of Orthopaedics, Frederiksberg Hospital, University Hospital of Copenhagen, Denmark
| |
Collapse
|
25
|
Abstract
Arthroplasty of the proximal humerus positions a prosthetic articular surface in relation to the humeral canal. Most descriptions of surgical technique recommend positioning the humeral component in 30 degrees to 45 degrees of retroversion. This study measured retroversion in relationship to the surgically reamed canal and introduced a method of measurement pertinent to prosthetic reconstruction. The canals of 21 cadaveric humeri were surgically reamed, the articular margins of the humeral heads were outlined with steel wire, and the trochlear axes were transfixed with Steinman pins. Under fluoroscopy the humeri were rotated on a jig that allowed rotation around the reamer and measurement of retroversion relative to the plane of the articular surface. Retroversion of the proximal humerus is highly variable, ranging in this study from 10 degrees to 55 degrees (mean 29.8 degrees). Anatomic reconstruction of the retroversion angle must be individualized. Palpation of the rotator cuff insertion is recommended prior to humeral head resection to avoid inadvertant cuff injury.
Collapse
Affiliation(s)
- M L Pearl
- Arthritis Service, Rancho Los Amigos Medical Center, Downey, CA, USA
| | | |
Collapse
|
26
|
Lachiewicz PF. Rheumatoid arthritis of the ankle: the role of total ankle arthroplasty. Semin Arthroplasty 1995; 6:187-92. [PMID: 10163524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The indications for total ankle replacement are limited to older patients with rheumatoid arthritis, especially those with multiple joint involvement and limited physical activity. The recommended surgical technique for total ankle arthroplasty includes an anterior surgical approach, minimal bone resection, and meticulous technique for cemented fixation of components. The results of published studies suggest total ankle arthroplasty should not be performed in patients who have had previous surgery on the ankle or foot, or who are younger than 57 years of age.
Collapse
Affiliation(s)
- P F Lachiewicz
- Division of Orthopaedic Surgery, University of North Carolina Hospitals, Chapel Hill, NC 27599-7055, USA
| |
Collapse
|
27
|
Abstract
Twenty-three shoulders in 23 patients with failed treatment of three- and four-part proximal humerus fractures subsequently treated with prosthetic arthroplasty were reviewed. The initial treatment was closed in 10 cases and open in 13. The complications of treatment included malunions in 17, nonunions in four, traumatic arthritis in 14, avascular necrosis in nine, humeral shortening in six, and deltoid paresis in four. In 20 cases prosthetic arthroplasty was performed an average of 15.8 months after injury. Three other cases had arthroplasty 19, 20, and 22 years after the original fracture. Seventeen were treated with a total shoulder arthroplasty, and six had a humeral head replacement. Thirteen had a tuberosity osteotomy, and eight had lengthening of the subscapularis tendon. Prosthetic arthroplasty reduced the shoulder pain in 22 (95%). Average active forward elevation increased from 68 degrees to 92 degrees, and active external rotation increased from 6 degrees to 27 degrees. After arthroplasty 53% of the patients were able to do activities at or above shoulder level compared with 15% before arthroplasty. Late surgery for failed early treatment is technically difficult, and the results are inferior to those reported for acute humeral head replacement. These findings should be considered when treatment is selected for acute three- and four-part proximal humerus fractures. Nonetheless late arthroplasty is a satisfactory reconstructive option when primary treatment of proximal humerus fractures fails.
Collapse
Affiliation(s)
- T R Norris
- California Pacific Medical Center, San Francisco, USA
| | | | | |
Collapse
|
28
|
Abstract
Dr. Jules Emile Péan is widely credited with having performed the first total shoulder replacement March 11, 1893, at the Hôpital International in Paris. However, in his original report Péan refers to the work of Themistocles Gluck as being the inspiration for his shoulder prosthesis, a fact understated if not completely overlooked during the last hundred years. This article therefore attempts to reappraise the relative contributions of these two pioneering surgeons to shoulder arthroplasty.
Collapse
Affiliation(s)
- M J Bankes
- Department of Orthopaedics, St. Mary's Hospital, London, United Kingdom
| | | |
Collapse
|
29
|
Abstract
A porous-coated humeral head replacement with biologic resurfacing of the glenoid was performed in 14 patients between 1989 and 1992. Six of the 14 patients had greater than 2 years of follow-up and form the basis of this report. The patients ranged in age from 33 to 54 years. Diagnoses were osteoarthritis in one, postreconstruction arthritis in four, and posttraumatic arthritis in one. The biologic resurfacing was done with either autogenous fascia lata or anterior shoulder capsule. All patients were relieved of pain. Average postoperative positions were elevation 138 degrees, external rotation 50 degrees, and internal rotation to the T12 spinous process. These results represent average increases of 57 degrees, 45 degrees, and six spinal segments, respectively. No donor site complications occurred. With Neer's rating scale there were five excellent results and one satisfactory result. We conclude that biologic resurfacing of the glenoid appears to improve the results of hemiarthroplasty and may well be the procedure of choice for young patients with end-stage glenohumeral arthritis.
Collapse
Affiliation(s)
- W Z Burkhead
- W. B. Carrell Memorial Clinic, Assoc., Dallas, TX 75204, USA
| | | |
Collapse
|
30
|
Pomerance JF. Painful basal joint arthritis of the thumb. Part II: Treatment. Am J Orthop (Belle Mead NJ) 1995; 24:466-72. [PMID: 7670869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Treatment of arthritis of the basal joint has evolved from resection of the trapezium, to joint replacement, to reconstruction of the lost anterior oblique ligament. These, along with other operative options, will be discussed in detail. The advantages and disadvantages of each will be presented. The complications of earlier methods of management have allowed refinements in surgical intervention. It is these improvements that have allowed the clinician to more reliably treat the arthritic thumb carpometacarpal joint.
Collapse
Affiliation(s)
- J F Pomerance
- Department of Orthopaedic Surgery, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA
| |
Collapse
|
31
|
Namba RS, Thornhill TS. Posterior capsulorrhaphy in total shoulder arthroplasty. A case report. Clin Orthop Relat Res 1995:135-9. [PMID: 7641471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The management of intraoperative posterior instability during total shoulder arthroplasty includes soft tissue balancing, reduction of humeral component retroversion, and augmentation of posterior glenoid defects. Severe instability caused by incompetence of the posterior capsule may require plication of the capsular remnant or a posterior muscle to the glenoid or proximal humerus. A technique of posterior capsulorrhaphy to the proximal humerus is described that does not require a separate surgical approach. By restoring stability, early range of motion exercises can be instituted, eliminating the need for postoperative immobilization. Posterior stability should be assessed during all total shoulder arthroplasties.
Collapse
Affiliation(s)
- R S Namba
- Department of Orthopaedic Surgery, University of California, San Francisco 94143-0728, USA
| | | |
Collapse
|
32
|
Ljung P, Ahlmann S, Knutson K, Rosén I, Rydholm U. Intraoperative monitoring of ulnar nerve function during replacement of the rheumatoid elbow via the lateral approach. Acta Orthop Scand 1995; 66:132-6. [PMID: 7740942 DOI: 10.3109/17453679508995506] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Neurography of the ulnar nerve was performed pre-, intra- and postoperatively in 8 arms of 7 patients with rheumatoid arthritis operated on with total elbow replacement via the lateral approach. Ulnar nerve decompression was performed in 4 elbows before implantation. A reduction in the amplitude of compound muscle action potential (CMAP) recorded from the abductor digiti minimi on stimulation of the ulnar nerve in the axilla, was observed during elbow dislocation at surgery in all patients, in 5 cases transiently and in 3 cases until the end of surgery. The ulnar nerve had been decompressed in all patients with lasting amplitude reduction. One of them had a mild sensory ulnar nerve palsy, while the other 2 had normal nerve function at the postoperative clinical examination. All 3 had a reduction in the amplitude of compound sensory nerve action potential (SNAP) and 2 of them also in CMAP amplitude at the postoperative neurographic examination. In patients with transient reduction during surgery, the CMAP amplitude quickly normalized on relocation of the elbow and both the SNAP and the CMAP were preserved at the postoperative neurographic examination. The authors conclude that dislocation of the laterally approached elbow carries a risk of ulnar nerve injury, which is not prevented by decompression of the ulnar nerve, but frequent relocation of the elbow during surgery seems important. It is suggested that the ulnar nerve should not be decompressed routinely, and that the dislocated elbow should be frequently relocated.
Collapse
Affiliation(s)
- P Ljung
- Department of Orthopedics, University Hospital, Lund, Sweden
| | | | | | | | | |
Collapse
|
33
|
Slawson SH, Everson LI, Craig EV. The radiology of total shoulder replacement. Radiol Clin North Am 1995; 33:305-18. [PMID: 7871171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The indications for total shoulder replacement and the radiologic evaluation prior to the operation are discussed in depth in this article. Different approaches to clinical problems are also discussed and illustrated, as are normal findings. This is followed by a discussion of the complications of shoulder reconstruction, including infection, fractures, and heterotopic bone formation. A review of the results is also given followed by a brief mention of a number of other orthopedic shoulder devices and plates.
Collapse
Affiliation(s)
- S H Slawson
- Department of Radiology, University of Minnesota Hospital and Clinics, Minneapolis
| | | | | |
Collapse
|
34
|
Kraay MJ, Figgie MP. Wrist arthroplasty with the trispherical total wrist prosthesis. Semin Arthroplasty 1995; 6:37-43. [PMID: 10155685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The clinical results and long-term implant survival of wrist arthroplasty with the Trispherical total wrist prosthesis was evaluated in patients with inflammatory arthritis. Using the Hospital for Special Surgery wrist scoring system, the clinical evaluation of 35 Trispherical total wrist arthroplasties showed an excellent result in 20, good result in 8, fair result in 3, poor result in 2, and failed result requiring revision in 2 wrists at an average follow-up of 9 years. Cumulative implant survival in 67 consecutive Trispherical total wrist arthroplasties was 97% at 5 years and 93% at 10 and 12 years postoperatively. Patient satisfaction with wrist arthroplasty using the Trispherical prosthesis was excellent. We attribute the favorable long-term results obtained with the use of this prosthesis to its inherent design that allows for accurate restoration of the center of rotation of the wrist.
Collapse
Affiliation(s)
- M J Kraay
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH 44106, USA
| | | |
Collapse
|
35
|
Lewis G, Vannappagari SR. Finite element stress analysis of the wrist joint without and with an endoprosthesis. Semin Arthroplasty 1995; 6:20-9. [PMID: 10155682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The finite element analysis method was used to obtain the lateral deformation profile and values of the von Mises stress in the cortical and cancellous regions of the various bones in models of a selected space in the coronal plane of a human wrist joint, without and with a prosthesis. The prosthesis was the metacarpal component of the Trispherical design of the total wrist joint arthroplasty. The models included all the bones, the associated network of ligaments, and the intervening soft muscle tissue. Each type of model was completely constrained along its entire proximal surface and subjected to either a static point force (in the axial compressive or anteroposterior tensile direction) acting at the center of the distal tip of the third metacarpal cortical bone. For the models containing the prosthesis, a parametric study was conducted involving the method of anchorage of the prosthesis to the contiguous bones and the material of fabrication of the prosthesis. It was found that: (1) the axial force produces lower stresses in the bones compared with the anteroposterior one; (2) no clear-cut case can be advanced, from the stress viewpoint, for press-fitting the prosthesis to the contiguous bones rather than using bone cement for such anchorage; and (3) any alloy with modulus of elasticity in the 79 to 196 GPa range and Poisson's ratio of about 0.3 may be used to fabricate the prosthesis. The approximations used and the associated limitations of the work are fully discussed, as are the design implications and clinical significance of the results.
Collapse
Affiliation(s)
- G Lewis
- Department of Mechanical Engineering, University of Memphis, TN 38152, USA
| | | |
Collapse
|
36
|
Lewis G. The total wrist joint arthroplasty: biomechanical considerations and research directions. Semin Arthroplasty 1995; 6:3-12. [PMID: 10155683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
A review of the state-of-the-art knowledge base on the biomechanics of the wrist joint, with emphasis on total wrist joint arthroplasty, is presented. The reasons for the reported high rate of aseptic loosening of the metacarpal component of such an implant are unknown at this time. It is suggested that detailed stress analyses of models of the joint, without and with the aforementioned implant, will yield results that will increase understanding of this problem and improve implant design, resulting in enhanced clinical performance of these replacements. For this purpose, it is recommended that the finite element analysis method be used.
Collapse
Affiliation(s)
- G Lewis
- Department of Mechanical Engineering, University of Memphis, TN 38152, USA
| |
Collapse
|
37
|
Abstract
Sixty-nine proximal interphalangeal joint silicone arthroplasties in 36 patients inserted through an anterior approach were reviewed. Average followup time was 3.4 years. The average extension deficit was slightly improved from 17 degrees to 8 degrees, but the total active motion (active flexion minus active extension) did not significantly increase (44 degrees to 46 degrees). Coronal plane deformities were not successfully corrected. Pain relief was obtained in 67 of 69 digits. There were 12 digits with complications, and five implants fractured. The anterior approach allows preservation of the central slip insertion and initiation of immediate active and passive joint motion. With proper indications, careful surgical technique, and a supervised therapy protocol, proximal interphalangeal joint silicone arthroplasty is a useful operation for pain relief and functional gain.
Collapse
Affiliation(s)
- H H Lin
- Department of Orthopaedic Surgery, University of Cincinnati College of Medicine, OH, USA
| | | | | |
Collapse
|
38
|
Abstract
We report our experience with a non-cemented wrist implant we developed in 1986. Between 1986 and 1991, 50 prostheses were implanted in 45 patients, 33 with rheumatoid arthritis and 12 with traumatic arthritis. After an average of 4.5 years (range, 2-6 years), we evaluated pain, daily activities, motion, grip strength, and x-ray films. The results were excellent in 24 wrists, good in 12, fair in 5, and poor in 8.
Collapse
Affiliation(s)
- H C Meuli
- Department of Orthopaedic Surgery, University of Berne, Switzerland
| | | |
Collapse
|
39
|
Schweitzer J, Zemmel NJ, Drake DB, Morgan RF, Bill TJ, Edlich RF. New instruments, bone liners, and tray for finger joint arthroplasty. J Long Term Eff Med Implants 1994; 5:147-53. [PMID: 10163358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Titanium circumferential grommets have been developed for finger joint arthroplasty that fit on the base of the silicone implant stems to protect the flexible hinge from tearing and fracture. To facilitate grommet insertion, new intramedullary bone rasps have been devised with a reverse cutting tooth pattern, an extended shaft for an improved view of the surgical field, and a redesigned cutting head to allow for grommet insertion. Surgical accessibility and ease of recognition have been facilitated by the development of color-coded sizers. All of the instruments necessary for finger joint surgery are available in a molded tray that has also been redesigned with a transparent lid and clearly labeled compartments for accurate determination of instruments and implant sizers.
Collapse
Affiliation(s)
- J Schweitzer
- Department of Plastic Surgery, University of Virginia School of Medicine, Charlottesville 22908, USA
| | | | | | | | | | | |
Collapse
|
40
|
O'Keefe JS, Schweitzer J, Bentrem DJ, Glasheen WP, Edlich RF. First metatarsophalangeal joint arthroplasties in the Commonwealth of Virginia. J Long Term Eff Med Implants 1994; 5:105-10. [PMID: 10163355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
This retrospective analysis of arthroplasty of the first metatarsophalangeal joint documents the incidence of surgery as well as the selection of the commercially available implants. During a 1-year period, 1994, arthroplasties were performed in 47 of the 1.7 million subscribers to Trigon Blue Cross Blue Shield of Virginia. Women received the majority of the arthroplasties (83%). Of the 47 cases, the silicone implant was predominantly used (83%). The most common indications for arthroplasty were hallux valgus (30%) and hallux rigidus (28%). Podiatrists performed 79% of the procedures, while orthopedic surgeons performed the remaining 21% of the cases. A prospective study is needed that will assess the long-term performance of the different implants.
Collapse
Affiliation(s)
- J S O'Keefe
- Department of Plastic Surgery, University of Virginia School of Medicine, Charlottesville 22908, USA
| | | | | | | | | |
Collapse
|
41
|
Schweitzer J, Bentrem DJ, Gabriel MC, Drake DB, Edlich RF. An overview of first metatarsophalangeal joint implant arthroplasty. J Long Term Eff Med Implants 1994; 5:93-104. [PMID: 10163359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The metatarsophalangeal joint of the great toe often requires an arthroplasty to correct joint disease and pain. Today, joint replacement systems are combinations of components manufactured to optimize biological ingrowth, mechanical interlock, press fit, and cementing. Three different types of arthroplasties are available to foot surgeons: the double stem hinged silicone implant, the two-component joint mimicking implant, and a hemi-implant available for the phalanx. No comprehensive studies on very large populations have been conducted to accurately evaluate the beneficial long-term effects of these implants. This review article describes the development of the toe arthroplasty, details the commercially available implants, and addresses the advantages and adverse effects of each implant.
Collapse
Affiliation(s)
- J Schweitzer
- Department of Plastic Surgery, University of Virginia School of Medicine, Charlottesville 22908, USA
| | | | | | | | | |
Collapse
|
42
|
Leslie LF, Faulkner BC, Woods JA, Hill RA, Thacker JG, Rodeheaver GT, Edlich RF. Wound cleansing by irrigation for implant surgery. J Long Term Eff Med Implants 1994; 5:111-28. [PMID: 10163356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Wound irrigation is an adjunct to all implant surgeries involving surgical incisions or arthroplasties. An understanding of the physics of wound irrigation provides a scientific basis for recommending wound irrigation systems for implant surgery. When inserting implants through surgical incisions, a low-pressure irrigation system is recommended for removing blood from the wound surface. In contrast, high-pressure irrigation systems are indicated to cleanse the intramedullary canal before cemented arthroplasty. With the advent of static and dynamic pressure transducers, irrigation systems can now be specifically designed to achieve these goals.
Collapse
Affiliation(s)
- L F Leslie
- Department of Plastic Surgery, University of Virginia School of Medicine, Charlottesville 22908, USA
| | | | | | | | | | | | | |
Collapse
|
43
|
Roth M. Metacarpophalangeal joint implant arthroplasty. AORN J 1994; 60:929-42; quiz 943-6. [PMID: 7864600 DOI: 10.1016/s0001-2092(07)68470-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Rheumatoid arthritis (RA) usually requires lifelong treatment and sometimes surgery. Metacarpophalangeal joint (MCPJ) implant arthroplasty is one surgical treatment for patients with severe RA malformation of the finger joints. Although not a cure, MCPJ implant arthroplasty can enhance patients' quality of life by improving their performance of independent activities of daily living. The silicone implant acts as a spacer until tendons and connective tissues are able to control the joint's functions. Comprehensive preoperative and postoperative patient teaching and aggressive physical therapy are needed to achieve optimal outcomes in patients who undergo this surgical procedure.
Collapse
Affiliation(s)
- M Roth
- Barnes Hospital, St. Louis
| |
Collapse
|
44
|
Kristiansen B, Pallesen P, Tørholm C. [Hemi-alloplasty in the treatment of proximal humeral fractures]. Ugeskr Laeger 1994; 156:6683-4. [PMID: 7839481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Twenty-four cases of displaced proximal humeral fractures were treated by hemiarthroplasty. No postoperative infections were seen. Follow-up was 24 month (range 12 to 62) in 19 patients. Pain relief was satisfactory in all patients but one. Functional results according to a modified Neer score system were good in nine, fair in eight and poor in two cases. No statistical differences in results in relation to postinjury delay or other parameters were found. Hemiarthroplasty is thus a safe treatment for displaced humeral fractures with a satisfactory end result.
Collapse
Affiliation(s)
- B Kristiansen
- Ortopaedkirurgisk afdeling, Amtssygehuset i Gentofte
| | | | | |
Collapse
|
45
|
Abstract
The lateral stability of the cadaver proximal interphalangeal joint was studied with an electromagnetic tracking system before and after implant replacement. Ten middle fingers were retrieved and randomly divided into two groups for joint replacement with either a silicone rubber flexible finger joint implant or a custom surface replacement prosthesis. Each finger was mounted on a fixture that allowed loading of the proximal interphalangeal joint with tension through the flexor, extensor, and intrinsic tendons. For the intact proximal interphalangeal joint under lateral stress, lateral angulation averaged 4 degrees in extension and 8 degrees with the joint in 60 degrees of flexion. Although lateral angulation increased after surface replacement prosthesis implantation when the joint was flexed more than 20 degrees, comparison with the intact joint showed no statistical difference. With the silicone implant, lateral angulation became more pronounced even in the extended position and showed a significant difference when the proximal interphalangeal joint was flexed more than 20 degrees.
Collapse
Affiliation(s)
- Y Minamikawa
- Division of Hand Surgery, Mayo Clinic, Rochester, MN 55905
| | | | | | | | | | | |
Collapse
|
46
|
Boileau P, Walch G, Noël E, Liotard JP. [Neer's shoulder prosthesis: results according to etiology]. Rev Rhum Ed Fr 1994; 61:607-18. [PMID: 7858594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The outcome of 80 glenohumeral arthroplasties with the Neer prosthesis in 77 patients with degenerative or inflammatory shoulder disease was evaluated after a mean follow-up of three years five months. The arthroplasties were performed because of intractable pain and functional disability due to destruction of the glenohumeral joint. The postoperative rehabilitation program focused on full recovery of joint motion and function in 65 cases and on joint stability with partial recovery of joint motion and function in 15 cases. According to the criteria developed by Neer, the outcome was excellent or satisfactory in 75% of cases and unsatisfactory in 25%. Constant's scores adjusted for age and gender varied widely across diagnostic categories, from a high of 76% in centered glenohumeral osteoarthritis (n = 40) to lows of 59% in rheumatoid arthritis (n = 21) and 45% in posttraumatic osteoarthritis (n = 10) or eccentric osteoarthritis due to cuff disruption (n = 9). At reevaluation, 70% of patients had little or no pain and 90% were satisfied with the outcome. The mean increase in flexion of the arm (39 degrees) was markedly influenced by the diagnosis. The increases in lateral rotation (mean 35 degrees) and medial rotation (four vertebral levels) of the arm were especially appreciated by the patients as having a very beneficial effect on the ability to perform everyday tasks. Complications included instability in three cases (two anterior dislocations and one posterior dislocation), glenoid component loosening in 11 cases (of which only four required reoperation) and rotator cuff tear in eight cases. Our results add to the existing evidence that nonconstrained shoulder implants, such as the Neer prosthesis, are both safe and effective in alleviating pain and improving joint function. They should be used in patients with refractory pain, disability due to restrictions in external and medial rotation of the arm and roentgenographic evidence of glenohumeral joint space loss.
Collapse
Affiliation(s)
- P Boileau
- Service d'Orthopédie et Traumatologie, CHU Nice, Hôpital Saint-Roch
| | | | | | | |
Collapse
|
47
|
Lu HS, Kou BL, Yuan YL. [Follow-up result of 14 cases of the first metatarsophalangeal joint arthroplasty with titanium total joint prostheses]. Zhonghua Wai Ke Za Zhi 1994; 32:542-4. [PMID: 7720426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
An 8-year follow-up study of 14 cases (22 feet) of titanium total 1st metatarsophalangeal joint arthroplasty with two designs (type I and type II) is reported. The follow-up period average was 5 years with a range of 3 to 8 years. The rate of subjective satisfaction was 72.7% (16/22), the incidence of complications 31.8% (7/22), and the rate of revision 27.3% (6/22). The results implicate that titanium total hallux MTP joint arthroplasty is a suitable procedure for osteoarthritis, rheumatoid arthritis and hallux rigidus of the 1st MTP joint, and that type II prosthesis seems better than type I prosthesis. In addition, prosthetic designing, surgical technique and postoperative complications are also discussed in detail.
Collapse
Affiliation(s)
- H S Lu
- Arthritis Clinic Research Center, People's Hospital, Beijing Medical University
| | | | | |
Collapse
|
48
|
Affiliation(s)
- R E Booth
- Rothman Institute, Philadelphia, PA 19107
| |
Collapse
|
49
|
|
50
|
Figgie MP, Gerwin M, Weiland AJ. Revision total elbow replacement. Hand Clin 1994; 10:507-20. [PMID: 7962154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Revision total elbow surgery is technically demanding with high complication rates. It requires precise preoperative planning and a surgeon prepared to use any of several surgical options during surgery. Satisfactory results can be achieved in complex cases.
Collapse
Affiliation(s)
- M P Figgie
- Hospital for Special Surgery, New York, New York
| | | | | |
Collapse
|