ABSTRACT
The orthopedic surgeon is faced with various challenging problems on the femoral side while performing a revision total hip arthroplasty. Some of these challenges may arise acutely or even intra operatively with limited resources. The aim of this study is to evaluate clinical and radiological outcomes with a single revision modular system used for various indications, and to determine whether such a system achieved initial fixation, femoral offset restoration, stability, and leg length equalization. We prospectively followed 33 patients with 36 implants for various indications. Functional assessment was achieved using the Harris hip score [HHS]. Hip stability, Leg length discrepancy, stem fixation, and offset restoration were evaluated radiographically. Follow up ranged from 24-87 months. HHS increased from a preoperative mean of 22.1 to a mean of 71.6 postoperatively. The total number of patients who had dislocation is 5 [13.9%]. Three stems were re-revised [9%]. Subsidence of the femoral component was less than 5mm in 30 patients [83%]. Leg length discrepancy was corrected to within 5mm in 53% of patients, Offset restoration was achieved in 39% of patients. No fractures at the body to stem junction were seen at latest follow up. Modular femoral stems are useful to address hip stability, leg length equalization, offset restoration, and distal fixation when revising a failed femoral component in the presence of significant proximal femur bone loss. These stems provide good clinical outcome in a simple, uniform, reproducible way
Subject(s)
Humans , Male , Female , Arthroplasty, Replacement, Hip , Leg Length Inequality , Prospective Studies , Plastic Surgery ProceduresABSTRACT
To evaluate the experience of the university of Jordan hospital regarding knee magnetic resonance imaging and to compare our findings with those published in the medical literature. 575 knee magnetic resonance imaging exams for 569 patients performed over the period of 10 years were reviewed. 109 patients, 66 males and 43 females with a percentage of [19.1%] had normal knee magnetic resonance image and were excluded from the study while the remaining 460 patients [80.9%] with variable abnormalities were included in our study. Variable knee pathologies were noted, the most common was knee fluid found in 381 patients representing [81.7%] of the pathologies detected, followed by bone marrow edema in 240 patients [51.5%], while cruciate ligament tear of the knee was found in 205 patients [43.99%], followed by meniscal tear in 184 patients [39.48%] and meniscal degeneration in 135 patients [28.96%]. Finally, osteoarthrosis which was the least common finding seen in 63 patients [13.5%]. Patients referred for knee magnetic resonance imaging scanning in the university of Jordan hospital showed diverse imaging findings with the most common abnormality detected being joint fluid followed by bone marrow edema and cruciate ligament tear. The great benefit from knee magnetic resonance imaging was in diagnosing meniscal tear, staging fractures and characterization of other miscellaneous pathologies. The prevalence of knee pathologies among our patients as revealed by knee magnetic resonance imaging was not in concordance with what is published in the literature especially for gender distribution of anterior cruciate ligament tear
ABSTRACT
The purpose of this study was to compare the effect of intravenous dexmedetomidine with the intravenous propofol adjuvant to spinal intrathecal anesthesia on the duration of spinal anesthesia and hemodynamic parameters during total knee replacement surgery. Seventy five patients were enrolled into this randomized study from the 1[st] of April 2008 till the 30[th] of August 2009 for total knee replacement surgery under spinal anesthesia. They were randomly assigned into three groups, group D, group P and group C. Following intrathecal injection with bupivacaine 12.5 mg in all patients in the three groups, patients in group D received intravenous loading dose of microg/kg/hr dexmedetomidine over 10 minutes and a maintenance dose of 0.2 to 0.5 p,g/kg/hr. Patients in group P received intravenous propofol 4 mg/Kg/hr over 10 min and a maintenance dose of 0.5-2 mg/Kg/hr. Patients in group C [control group] received nothing extra to the regular IV fluid. The regression times to reach SI sensory level and Bromage 0 motor scale, the hemodynamic parameters, the Bispectral Index level of Sedation [BIS], and arterial CO[2] level were recorded. The regression time to reach SI dermatome was 149.4 +/- 14.6 min in group C, 152.8 +/- 16.6 min in group P and 209.6 +/- 25.9 min in group D. The regression to Bromage 0 was!84.6 +/- 22.8 min in group C, 190.0 +/- 21.0 min in group P, and 255.8 +/- 36.7 min in group D. Statistical analysis of regression of sensory and motor block was significant among groups [C vs. D, P vs. D, P < 0.05]. The heart rate was significantly decreased in group D in comparison to groups C and P. Sedation levels were within accepted ranges in groups D and P and not affected in the control group. Minimal respiratory depression occurred in group P and D, clinically it was not significant. Supplementation of spinal anesthesia with intravenous dexmedetomidine or propofol produces good sedation levels without significant clinical hemodynamic changes. Adding dexmedetomidine produces significantly longer sensory and motor block than propofol