RESUMO
OBJECTIVES: Historically, arthroplasty in systemic lupus erythematosus (SLE) patients has been less successful than for patients with osteoarthritis (OA). It is not known if SLE remains an independent risk factor for poor arthroplasty outcomes or if other factors, such as avascular necrosis (AVN), continue to play a role. METHODS: A case-control study using data from a single-institution arthroplasty registry compared SLE total hip arthroplasty (THA) and total knee arthroplasty (TKA) with OA controls matched by age, gender and presence of AVN. Baseline, two-year administrative and self-report data, and diagnosis leading to arthroplasty were evaluated. RESULTS: A total of 54 primary SLE THA and 45 primary SLE TKA were identified from May 2007 through June 2011. AVN was present in 32% of SLE THA and no TKA. SLE THA had worse preoperative WOMAC pain (42.5 vs. 52.7; p = 0.01) and function (38.8 vs. 48.0; p = 0.05) compared with OA. However, at two years there was no difference in WOMAC pain (91.1 vs. 92.1; p = 0.77) or WOMAC function (86.4 vs. 90.8; p = 0.28). SLE TKA were similar to OA in both preoperative pain (42.6 vs. 48.4; p = 0.14) and function (42.1 vs. 46.8; p = 0.30) and two-year pain (85.7 vs. 88.6; p = 0.50) and function (83.7 vs. 85.1; p = 0.23). Compared to OA, SLE THA and TKA patients had more renal failure (14% vs. 1%; p = 0.007) and hypertension (52% vs. 29%; p = 0.009). In a multivariate linear regression, SLE was not predictive of either poor pain or poor function. CONCLUSIONS: While SLE patients have more comorbidities than OA, and SLE THA have worse preoperative pain and function compared with OA controls, SLE was not an independent risk factor for poor short-term pain or function after either hip or knee arthroplasty.
Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Lúpus Eritematoso Sistêmico/fisiopatologia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteonecrose/fisiopatologia , Estudos Prospectivos , Qualidade de Vida , Fatores de Risco , Resultado do TratamentoRESUMO
Severe factor XI (sFXI) deficiency is a rare bleeding disorder (RBD). FXI replacement is most often required for surgical hemostasis. Plasma, the sole US treatment option, is often complicated by life-threatening allergic reactions. In such circumstances, the FDA offers a mechanism for institution-industry collaboration to facilitate limited use of replacement products licensed abroad. A 58 years old man with sFXI deficiency, required hip replacement. In the past, he received prophylactic plasma for thyroidectomy and experienced a severe allergic reaction. A single use institutional IND FDA application was initiated in collaboration with LFB (Les Ulis, France) to access Hemoleven®, a plasma-derived FXI concentrate. The application required an investigator-initiated IRB-approved protocol for treatment and safety/efficacy monitoring that included: preoperative thrombophilia, FXI inhibitor and pharmacokinetic (PK) evaluations; peri- postoperative administration of ≤ 4 doses of 10-15 U/kg Hemoleven® ; DIC monitoring; postoperative thromboprophylaxis; observation for product efficacy and potential complications. PK study demonstrated the expected 1.8% FXI recovery per U/kg with half-life of 62 hours. Mild D-Dimer elevation was noted 6-9 hours post-infusion. The initial dose (15 U/kg) was administered 15 hours before surgery; subsequently, 3 doses (10 U/kg) were infused every 72 hours. Hemostasis was excellent. No complications were observed. Collaboration allowed for successful patient access to Hemoleven® with excellent PK, safety, and efficacy. This case underscores the need for additional efforts to ensure safe and effective licensed replacement therapies for RBD patients.
Assuntos
Anticoagulantes/uso terapêutico , Artroplastia de Quadril , Deficiência do Fator XI/tratamento farmacológico , Fator XI/uso terapêutico , Artroplastia de Quadril/métodos , Perda Sanguínea Cirúrgica/prevenção & controle , Hemostasia Cirúrgica/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
We analyzed three factors involved in fractures and dislocations of the cervical spine and their relation to the degree of injury of the spinal cord. The three factors were the space available for the spinal cord at the level of the injury, the sagittal diameter of the spinal canal at the uninjured levels, and the Pavlov ratio at the uninjured levels. Of the 288 patients analyzed, eighty-three had a complete injury of the spinal cord, ninety-two had an incomplete injury of the spinal cord, thirty had an isolated nerve-root injury, and eighty-three had no neurological deficit. The mean space available for the spinal cord at the level of the injury was 10.5 millimeters for the patients who had a complete injury of the spinal cord, 13.1 millimeters for those who had an incomplete injury of the spinal cord, 15.9 millimeters for those who had an isolated nerve-root injury, and 16.7 millimeters for those who had no neurological deficit. The difference between the groups was significant (p < 0.001) except for the difference between the patients who had an isolated nerve-root injury and those who had no neurological deficit. The mean sagittal diameter of the canal at the uninjured levels was 16.1 millimeters for the patients who had a complete injury of the spinal cord, 16.1 millimeters for those who had an incomplete injury of the spinal cord, 17.9 millimeters for those who had an isolated nerve-root injury, and 18.1 millimeters for those who had no neurological deficit. The difference between the patients who had a complete injury of the spinal cord and those who had an incomplete injury of the spinal cord and that between the patients who had an isolated nerve-root injury and those who had no neurological deficit were not significant (p > 0.05). However, the patients who had a complete injury of the spinal cord and those who had an incomplete injury of the spinal cord were significantly different from the patients who had an isolated nerve-root injury and those who had no neurological deficit (p < 0.001). The mean Pavlov ratio at the uninjured levels was 0.82 for the patients who had a complete injury of the spinal cord, 0.84 for those who had an incomplete injury of the spinal cord, 0.96 for those who had an isolated nerve-root injury, and 0.96 for those who had no neurological deficit.(ABSTRACT TRUNCATED AT 400 WORDS)
Assuntos
Vértebras Cervicais/lesões , Luxações Articulares/patologia , Traumatismos da Medula Espinal/patologia , Fraturas da Coluna Vertebral/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais/diagnóstico por imagem , Feminino , Humanos , Luxações Articulares/complicações , Luxações Articulares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Traumatismos da Medula Espinal/diagnóstico por imagem , Traumatismos da Medula Espinal/etiologia , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico por imagemRESUMO
Deep infection was a complication after twelve (7.3 per cent) of 164 primary total elbow replacements. Two additional patients who had an infection about an elbow prosthesis were referred for treatment after total elbow replacement elsewhere. A statistical analysis of all of these primary total elbow arthroplasties, including the two in patients who were referred from outside institutions, identified preoperative factors that placed a patient at significant risk for subsequent infection. The risk factors included a previous operation on the elbow, a previous infection in the region of the elbow, psychiatric illness, class-IV rheumatoid arthritis, drainage from the wound after operation, spontaneous drainage after ten days, and reoperation for any reason. Three modes of treatment were used for patients who had an established infection: débridement and salvage of the implant, resection arthroplasty, and arthrodesis. After early operative débridement and suppression of the infection with long-term antibiotic therapy, three patients were able to retain the prosthesis, with restoration of range of motion and function of the upper extremity. One prosthesis was reimplanted after a six-week course of intravenous administration of antibiotics.
Assuntos
Articulação do Cotovelo/cirurgia , Prótese Articular/efeitos adversos , Infecção da Ferida Cirúrgica/cirurgia , Adolescente , Adulto , Idoso , Antibacterianos/uso terapêutico , Artrodese , Distribuição de Qui-Quadrado , Desbridamento , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Reoperação , Estudos Retrospectivos , Fatores de Risco , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/etiologia , Infecções Estafilocócicas/cirurgia , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/etiologiaRESUMO
Sixteen patients who received nineteen semiconstrained total elbow replacements for complete ankylosis of the elbow were followed for an average of five and three-quarters years (range, two to twelve years). The average preoperative elbow score was 23 points and the average postoperative score was 84 points. Postoperatively, the average flexion was 115 degrees; extension, 35 degrees; and pronation and supination, 95 degrees. There were fifteen excellent or good results. There was one failure due to a deep infection, but after removal of the prosthesis a satisfactory fascial arthroplasty was achieved in this elbow. Function was improved in all patients, and all patients had relief of the preoperative pain. For the arthroplasty to succeed, the patient must have a good understanding of the procedure and must be willing and able to comply with the postoperative rehabilitation program. The use of a semiconstrained, often custom-fit, implant is necessary. The Bryan-Morrey posteromedial approach to the elbow is recommended for the procedure, since this approach allows early institution of range-of-motion exercises.
Assuntos
Anquilose/cirurgia , Articulação do Cotovelo/cirurgia , Prótese Articular , Adolescente , Adulto , Idoso , Anquilose/diagnóstico por imagem , Anquilose/fisiopatologia , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/fisiopatologia , Feminino , Humanos , Masculino , Métodos , Pessoa de Meia-Idade , Movimento , Complicações Pós-Operatórias , Radiografia , Estudos RetrospectivosRESUMO
Between May 1975 and December 1979, 113 patients had 153 arthroplasties using a total condylar knee prosthesis. Thirty patients (forty-two knees) died, and one (two knees) was lost to follow-up. Thirty-eight of these forty-four knees had been followed for more than two years, and none had had a revision. The remaining eighty-two patients (109 knees) were followed for an average of nine years (range, seven to 11.5 years). At the time of the latest examination, ten had had a revision for various reasons. For the ninety-nine knees that had the original prosthesis, the findings were compared with those of an evaluation that had been done four years postoperatively. The average over-all knee score was found to have decreased between the four-year and the latest follow-up evaluation, primarily because of a 7-point decrease in the score for function. The rate of infection was 0.6 per cent. The knees that had had patellar resurfacing had better over-all scores and better scores for pain than those that had not. This was particularly true in the patients who had osteoarthritis. The results of arthroplasty using a total condylar prosthesis appeared to be consistent and durable. Although there was a decrease in the quality of the functional result with increasing age, the patients reported consistent relief of pain.
Assuntos
Artrite Reumatoide/cirurgia , Articulação do Joelho/cirurgia , Prótese do Joelho , Osteoartrite/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrite Reumatoide/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Articulação do Joelho/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Osteoartrite/diagnóstico por imagem , Cuidados Pós-Operatórios , Complicações Pós-Operatórias , Falha de Prótese , Radiografia , ReoperaçãoRESUMO
The results in thirty-six knees that had a fracture of the patella after a total condylar arthroplasty were reviewed, and were analyzed according to the type of fracture and the alignment of the implant and the limb. Most of the fractures occurred two years or less after the initial operation. Fourteen knees were rated fair or poor and twenty-two, good or excellent. None of the thirty-six implants had been aligned in the neutral range. In sixteen knees, the alignment had a minor variation from the neutral range--that is, the knees were in minor malalignment. In general, these knees had the least severe fractures and the best over-all results. All had a good or excellent result except one, which was revised because of a loose patellar component. That knee was rated as fair at the latest follow-up. There was a major discrepancy in the alignment of twenty implants. These knees had more severe fractures and less satisfactory results than those in the other group. In two of these knees, the fracture was treated non-operatively; one had a good and the other, a poor result. Twelve of the remaining knees, which were treated surgically, were rated as fair or worse. Two knees that had revision of three components and restoration of alignment to the neutral range had an excellent result. The results of this study indicate that the alignment and fit of a component are important in determining the severity of a fracture of the patella after condylar total knee replacement and the long-term results after treatment of the fracture.
Assuntos
Fraturas Ósseas/etiologia , Prótese do Joelho/efeitos adversos , Patela/lesões , Adulto , Idoso , Fraturas Ósseas/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Patela/diagnóstico por imagem , RadiografiaRESUMO
Fourteen patients in whom open reduction and internal fixation could not be achieved satisfactorily had a total elbow arthroplasty for non-union of a supracondylar humeral fracture. All patients had an established non-union, and ten had had from one to four previous attempts at internal fixation. The average age at the time of operation was sixty-five years. The average duration of follow-up was five years, with a minimum of two years. The average preoperative elbow score was 17 points, with both pain and functional disability present. The average postoperative score was 84 points; there were eight good or excellent results and three failures. The latter three patients had an additional operation: one each for dislocation, loosening of the humeral component, and deep infection. Salvage of supracondylar non-union by means of a total elbow arthroplasty is a technically demanding procedure. Strict indications for selection of patients must be followed. A semiconstrained implant is recommended, with preservation of the epicondyles and their muscular attachments in order to achieve balance of the soft tissues.
Assuntos
Articulação do Cotovelo/cirurgia , Fraturas não Consolidadas/cirurgia , Fraturas do Úmero/cirurgia , Prótese Articular , Adulto , Idoso , Feminino , Seguimentos , Fraturas não Consolidadas/fisiopatologia , Humanos , Fraturas do Úmero/fisiopatologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Reoperação , CicatrizaçãoRESUMO
We used survival analysis to evaluate 113 consecutive semiconstrained total elbow arthroplasties (TEAs) in 95 patients at a maximum follow-up of 99 months. Our criteria for failure were mechanical malfunction, revision for any reason, and deep infection. The primary diagnosis was inflammatory arthritis in 86 elbows, post-traumatic arthritis in 6, supracondylar nonunion or fracture in 12, osteoarthritis in 2 and other causes in 3. Seven failures were due to deep infection, and five of these had a primary diagnosis of inflammatory arthritis. Eight failures were revised or had revision recommended for aseptic loosening, and six of these were in patients with post-traumatic arthritis or supracondylar nonunion. The cumulative survival for TEAs performed for post-traumatic arthritis, fractures or supracondylar nonunion was 73% at three years and 53% at five years, significantly worse than the cumulative three- and five-year survivals of 92% and 90%, respectively, for patients with inflammatory arthritis. TEA with a semiconstrained prosthesis appears to have a satisfactory survival in selected patients with arthritic disorders. The incidence of deep infection was reduced by improvements in surgical technique and postoperative management, and the routine use of antibiotic-impregnated cement. The incidence of aseptic loosening was low, except in patients with supracondylar nonunion or post-traumatic arthritis.
Assuntos
Articulação do Cotovelo/cirurgia , Prótese Articular , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrite/etiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/etiologia , Complicações Pós-Operatórias , Falha de Prótese , Estudos RetrospectivosRESUMO
Unconstrained total shoulder arthroplasty is a highly effective and successful operation in the patient with rheumatoid arthritis. Reliable pain relief can be obtained, often with an improvement in range-of-motion and function of the entire extremity. Rheumatoid patients may present with difficult soft-tissue and bony deficiencies, but careful planning and intraoperative procedures help to maximize the outcome and minimize the possible complications.
Assuntos
Artrite Reumatoide/cirurgia , Artroplastia de Substituição/métodos , Articulação do Ombro/cirurgia , Artrite Reumatoide/patologia , Artrite Reumatoide/fisiopatologia , Artrite Reumatoide/reabilitação , Artroplastia de Substituição/efeitos adversos , Artroplastia de Substituição/reabilitação , Humanos , Úmero/patologia , Úmero/cirurgia , Cuidados Intraoperatórios , Dor/cirurgia , Planejamento de Assistência ao Paciente , Amplitude de Movimento Articular/fisiologia , Ombro/patologia , Ombro/cirurgia , Articulação do Ombro/patologia , Articulação do Ombro/fisiopatologia , Resultado do TratamentoRESUMO
Patellofemoral symptoms are now the most common cause of aseptic knee revision; however, the majority of patello-femoral problems are self-limited and may be managed symptomatically and nonoperatively. A trial of anti-inflammatory medications, stretching exercises, and appropriate bracing is always indicated. Patellofemoral symptoms are usually related to mechanical malalignment of all three components of the total knee arthroplasty. Attention to the fundamental principles of total knee arthroplasty, including restoration of the bony mechanical alignment, soft tissue stability, and maintenance of the anatomic joint line, prevents many of the problems. Meticulous preoperative planning and anatomic placement of the component parts are important for a satisfactory long-term outcome. Present research is directed to providing kinematic analysis of the patellofemoral tracking mechanism and to minimizing patellofemoral contact stresses with appropriate new designs.
Assuntos
Prótese do Joelho , Fenômenos Biomecânicos , Humanos , Dor Pós-Operatória , Patela , Desenho de Prótese , Falha de Prótese , ReoperaçãoRESUMO
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.
Assuntos
Articulação do Cotovelo/cirurgia , Prótese Articular , Artrodese , Artroplastia , Humanos , Prótese Articular/efeitos adversos , Prótese Articular/métodos , Cuidados Pós-Operatórios , Próteses e Implantes , Falha de Prótese , Infecções Relacionadas à Prótese/etiologia , ReoperaçãoRESUMO
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.
Assuntos
Artrite Reumatoide/cirurgia , Prótese Articular/instrumentação , Articulação do Punho/cirurgia , Adulto , Idoso , Artrite Reumatoide/fisiopatologia , Estudos de Avaliação como Assunto , Feminino , Seguimentos , Humanos , Prótese Articular/métodos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Desenho de Prótese , Falha de Prótese , Amplitude de Movimento Articular , Articulação do Punho/patologiaRESUMO
Blood loss during total knee replacement (TKR) remains a significant concern. In this study, 114 patients underwent TKR, and were divided into two groups based on whether they received a new generation fibrin sealant intra-operatively, or a local infiltration containing adrenaline. Groups were then compared for mean calculated total blood volume (TBV) loss, transfusion rates, and knee range of movement. Mean TBV loss was similar between groups: fibrin sealant mean was 705 ml (281 to 1744), local adrenaline mean was 712 ml (261 to 2308) (p = 0.929). Overall, significantly fewer units of blood were transfused in the fibrin sealant group (seven units) compared with the local adrenaline group (15 units) (p = 0.0479). Per patient transfused, significantly fewer units of blood were transfused in the fibrin sealant group (1.0 units) compared with the local adrenaline group (1.67 units) (p = 0.027), suggesting that the fibrin sealant may reduce the need for multiple unit transfusions. Knee range of movement was similar between groups. From our results, it appears that application of this newer fibrin sealant results in blood loss and transfusion rates that are low and similar to previously applied fibrin sealants.
Assuntos
Artroplastia do Joelho , Perda Sanguínea Cirúrgica/prevenção & controle , Adesivo Tecidual de Fibrina/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue/estatística & dados numéricos , Volume Sanguíneo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Amplitude de Movimento Articular , Resultado do TratamentoRESUMO
OBJECTIVE: To provide evidence-based recommendations for the treatment of patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (SpA). METHODS: A core group led the development of the recommendations, starting with the treatment questions. A literature review group conducted systematic literature reviews of studies that addressed 57 specific treatment questions, based on searches conducted in OVID Medline (1946-2014), PubMed (1966-2014), and the Cochrane Library. We assessed the quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method. A separate voting group reviewed the evidence and voted on recommendations for each question using the GRADE framework. RESULTS: In patients with active AS, the strong recommendations included use of nonsteroidal antiinflammatory drugs (NSAIDs), use of tumor necrosis factor inhibitors (TNFi) when activity persists despite NSAID treatment, not to use systemic glucocorticoids, use of physical therapy, and use of hip arthroplasty for patients with advanced hip arthritis. Among the conditional recommendations was that no particular TNFi was preferred except in patients with concomitant inflammatory bowel disease or recurrent iritis, in whom TNFi monoclonal antibodies should be used. In patients with active nonradiographic axial SpA despite treatment with NSAIDs, we conditionally recommend treatment with TNFi. Other recommendations for patients with nonradiographic axial SpA were based on indirect evidence and were the same as for patients with AS. CONCLUSION: These recommendations provide guidance for the management of common clinical questions in AS and nonradiographic axial SpA. Additional research on optimal medication management over time, disease monitoring, and preventive care is needed to help establish best practices in these areas.(AU)
Assuntos
Humanos , Espondilite Anquilosante/tratamento farmacológico , Espondilite Anquilosante/terapia , Anti-Inflamatórios não Esteroides/uso terapêutico , Antirreumáticos/uso terapêutico , Espondilartrite/tratamento farmacológico , Glucocorticoides/uso terapêutico , Modalidades de Fisioterapia , Fator de Necrose Tumoral alfa/uso terapêutico , Adalimumab/uso terapêutico , Infliximab/uso terapêutico , Etanercepte/uso terapêuticoRESUMO
This study analyzes the results of treatment of 22 patients with 24 supracondylar femur fractures above a total knee arthroplasty. Ten knees were treated by closed methods utilizing traction and then a cast, 10 knees with immediate open reduction and internal fixation, 2 knees with a custom total knee integrated with a distal femoral allograft, 1 knee with external fixation, and 1 knee with primary arthrodesis. Nine fractures treated by closed means and 5 fractures treated by open reduction and internal fixation healed primarily. Two of the 5 surgical failures healed after replating and bone graft. The 3 failures of surgical therapy were salvaged utilizing custom total knee arthroplasty, 2 of which required integration with a distal femoral allograft. One knee treated with external fixation developed a deep infection necessitating implant removal and arthrodesis. Twelve of the 14 femoral fractures that united primarily healed with the femoral component in varus with respect to the long axis of the anatomic femur. Nine of these 12 implants developed progressive radiolucent lines at the tibial component. Three of these knees have required implant revision due to progressive loosening of the tibial and/or femoral components. The results of this evaluation indicate that fractures above a well-fixed total knee arthroplasty are difficult to manage. If anatomical alignment cannot be achieved by simple closed techniques, then primary open reduction and internal fixation should be considered. However, because of the complexity of the problem, the surgeon should be prepared to perform a primary arthrodesis or revision using custom components with or without a distal femoral allograft.
Assuntos
Fraturas do Fêmur/terapia , Prótese do Joelho , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/cirurgia , Fixação de Fratura/métodos , Humanos , Articulação do Joelho/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Falha de Prótese , Radiografia , ReoperaçãoRESUMO
The results of 65 consecutive revision total knee arthroplasties performed for mechanical failure were reviewed. Fifty-nine of the knees were followed for an average of five years (range, 2-10 years). The types of implants used included: total condylar, posterior stabilized, total condylar III, and the kinematic rotating hinge prostheses. Only 46% of the knees were considered excellent or good; 42% either had poor results or failed. The infection rate was 4.5%. Poor results were generally caused by patellofemoral problems and kinematic abnormalities. Revision total knee arthroplasty is a technically demanding procedure that can improve function when anatomic relationships of the knee are restored.
Assuntos
Prótese do Joelho , Idoso , Artroplastia/métodos , Feminino , Seguimentos , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiologia , Masculino , Movimento , Desenho de Prótese , Falha de Prótese , Radiografia , ReoperaçãoRESUMO
Twenty-five consecutive nonunions or delayed unions of the femoral shaft were treated by a fluted intramedullary rod. Fourteen patients were men; 11 were women. Sixteen fractures represented failures of closed management. Five patients had failures of primary open reduction and internal fixation. Four patients had had one attempt at operative treatment of nonunion. All but one fracture united. The one exception required a second procedure. Excellent bending and rotary fixation were achieved and union occurred promptly in most cases. Iliac crest bone grafting was not routinely required for good results. There were no major complications in this series. Two patients with severe knee extension contractures required quadricepsplasty at a later date to recover knee motion. One fracture healed with a 15 degree valgus malunion. The strength and rigidity make this device extremely reliable for the treatment of femoral shaft nonunion.
Assuntos
Fraturas do Fêmur/cirurgia , Fixação Intramedular de Fraturas/instrumentação , Fraturas não Consolidadas/cirurgia , Adolescente , Adulto , Idoso , Placas Ósseas , Transplante Ósseo , Criança , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fraturas não Consolidadas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , CicatrizaçãoRESUMO
Fifty patients with rheumatoid arthritis had 59 Swanson implants of the metacarpal-phalangeal joint of the thumb. Eleven patients (15 implants) have since died and only 1 patient (1 implant) has been lost to follow-up leaving 43 implants available for study. The most common preoperative deformity was a boutonniere deformity with a flexible interphalangeal joint. All thumbs had less pain after operation. The average range of active motion is 25 degrees, with a flexion arc from 15 to 40 degrees. There is an average key pinch strength of 4 pounds (range, 0.5 to 10). Improvement in activities of daily living were noted in 40 hands. One thumb required reoperation for instability; the implant was removed and a metacarpal-phalangeal arthrodesis was done. Radiographic progression of disease was noted in only one thumb at the interphalangeal joint and in two other thumbs at the carpometacarpal joint. None of these have required further operations. The maintenance of motion appears to help in activities of daily living as stability and pinch strength are often adequate.