ABSTRACT
Survivorship analysis is a useful way of expressing the long-term results of joint replacement: it provides a means of comparing the life span of one type of prosthesis with another. However, such studies should include a full life-table and the confidence intervals for the survival rates at given times. At least 40 surviving prostheses are required to provide reliable results.
Subject(s)
Confidence Intervals , Knee Prosthesis , Prosthesis Failure , Follow-Up Studies , Humans , Predictive Value of Tests , ReoperationABSTRACT
We have reviewed 15 patients with infected total knee replacements after removal of the prosthesis, rigorous debridement, antibiotic irrigation, and prolonged systemic antibiotics. Infection was permanently eradicated in all patients; they were left with a functioning limb, on which they could walk with either a caliper (8 patients), a simple splint (3), crutches, or sticks. Three were disappointed because of residual pain. We believe that, if exchange arthroplasty is inappropriate, this procedure is preferable to arthrodesis or amputation for persistent and disabling infection, particularly where constrained artificial joints have been used.
Subject(s)
Arthroplasty , Infections/surgery , Knee Joint/surgery , Knee Prosthesis , Postoperative Complications/surgery , Aged , Aged, 80 and over , Anti-Bacterial Agents/administration & dosage , Debridement , Female , Humans , Male , Middle Aged , Pain , Reoperation , Therapeutic IrrigationABSTRACT
Plasma cells synthesising rheumatoid factor have been identified by immunofluorescent studies of sections of cells eluted from synovial membranes poor in macrophages. More than 90% of the IgM plasma cells produce rheumatoid factor, while 50 to 60% of IgG plasma cells and only 10% of IgA plasma cells produce rheumatoid factor. The equivalent results obtained in patients with sero-positive and sero-negative rheumatoid arthritis suggest that auto-immunisation between the IgG plays the same determinant role in the pathophysiology of the two types of rheumatoid arthritis.
Subject(s)
Arthritis, Rheumatoid/metabolism , Plasma Cells/metabolism , Rheumatoid Factor/biosynthesis , Synovial Membrane/metabolism , Humans , Immunoglobulin A/immunology , Immunoglobulin G/immunology , Immunoglobulin M/immunology , Immunologic Techniques , Plasma Cells/immunology , Synovial Membrane/pathologyABSTRACT
Between 1970 and 1982, 50 total elbow replacements were carried out for rheumatoid arthritis using the Stanmore prosthesis. A long-term follow-up of the 44 elbows available for review is presented. Thirty-four of these (77%) had good results, five were fair, and five were poor. The complications and limitations are discussed.
Subject(s)
Arthritis, Rheumatoid/surgery , Elbow Joint/surgery , Joint Prosthesis , Adult , Aged , Arthritis, Rheumatoid/diagnostic imaging , Arthritis, Rheumatoid/physiopathology , Elbow Joint/diagnostic imaging , Elbow Joint/physiopathology , Equipment Failure , Female , Follow-Up Studies , Humans , Joint Prosthesis/adverse effects , Male , Middle Aged , Movement , Pain Management , RadiographyABSTRACT
Plasma cells synthesizing rheumatoid factors (RF) were identified by fluorescent staining of sections of synovium and macrophage-depleted cells from dispersed synovial tissue. The latter avoided problems related to sampling errors in studying tissue sections and in the uncertainty raised by the staining of macrophages with intracellular complexes. Plasma cells producing IgG predominated, and seropositive patients had a higher proportion of IgM producers than seronegative subjects. None the less, in both groups of patients more than 90% of the IgM plasma cells were synthesizing RF, whereas the corresponding figure for IgG was between 50% and 60%. Only around 10% of IgA plasma cells were positive for RF. The high percentage of IgM plasma cells making RF would tend to argue for an IgG-specific response and against direct polyclonal activation as the stimulus. The percentage of IgG-producing cells positive for RF is also consistent with a dominant response to IgG. Accepting the difference in the relative proportion of total IgM- to IgG-producing plasma cells in seropositive as against seronegative patients, the close similarity between the two groups in the fraction of cells making RF favours the view that the two groups have a comparable underlying immunopathology dependent on IgG autosensitization. From the technical standpoint, the dispersed cell method gives results in line with those obtained with sections but which are easier to read, whereas the fluorescent techniques described give clear and reproducible results for the detection of RF of different heavy-chain isotype.
Subject(s)
Antibody-Producing Cells/classification , Arthritis, Rheumatoid/immunology , Immunoglobulins/classification , Plasma Cells/classification , Synovial Membrane/cytology , Adult , Aged , Antibodies, Anti-Idiotypic/biosynthesis , Antibody Specificity , Antibody-Producing Cells/metabolism , Humans , Immunoglobulin A/biosynthesis , Immunoglobulin G/biosynthesis , Immunoglobulin M/biosynthesis , Leukocyte Count , Middle Aged , Plasma Cells/metabolism , Rheumatoid Factor/biosynthesisABSTRACT
Between 1969 and 1971 20 prototypes of the Stanmore total knee prosthesis were used to replace severely arthritic knees in 18 patients. Seven patients died before the final follow-up and one had to have her leg amputated because of deep infection; in none of these patients had the prosthesis become loose. Ten patients (11 knees) were reviewed at least 10 years after operation. There was no significant clinical deterioration in 7 of these 11 surviving knees when the results at one year were compared with those at 10 years.
Subject(s)
Knee Prosthesis , Adult , Aged , Alloys/therapeutic use , Amputation, Surgical , Arthritis, Rheumatoid/surgery , Female , Follow-Up Studies , Humans , Knee Joint/physiopathology , Knee Prosthesis/mortality , Leg/surgery , Methods , Middle Aged , Movement , Osteoarthritis/surgery , ReoperationABSTRACT
We review 210 Stanmore knee replacements in 163 patients to assess the survival of the prostheses and the long-term results. The annual rate of failure reached a maximum of 4.6% in the fourth year after operation; thereafter it declined to reach zero by the eighth year. Between two and eight years after operation, 66.3% of the surviving knees were completely free of pain and 30.2% had mild retropatellar pain. Fixed flexion deformities present before operation were completely corrected in 73% of the knees, and varus or valgus deformities were invariably corrected. Stability was always restored to unstable knees and 80.8% of knees flexed to 90 degrees or more after replacement. Aseptic loosening (8.1%), prosthetic infection (4.3%) and femoral fracture (2.9%) led to 8.5% of the prostheses being revised or removed over eight years. Modifications in prosthetic design and operative techniques have been introduced to minimise such complications in the future.
Subject(s)
Knee Prosthesis , Adult , Age Factors , Aged , Alloys/therapeutic use , Arthritis, Rheumatoid/surgery , Evaluation Studies as Topic , Female , Follow-Up Studies , Humans , Knee Joint/physiopathology , Knee Joint/surgery , Knee Prosthesis/adverse effects , Knee Prosthesis/standards , Male , Methods , Middle Aged , Osteoarthritis/surgery , Pain, Intractable/therapy , Prosthesis Design , Time FactorsSubject(s)
Joint Prosthesis , Shoulder Joint/surgery , Adult , Aged , Female , Humans , Joint Prosthesis/adverse effects , Male , Middle Aged , Movement , Pain , Postoperative ComplicationsSubject(s)
Joint Prosthesis , Ankle Joint/surgery , Elbow Joint/surgery , Hip Prosthesis , Humans , Joint Prosthesis/instrumentation , Knee Prosthesis , Metacarpophalangeal Joint/surgery , Metatarsophalangeal Joint/surgery , Methods , Postoperative Complications , Shoulder Joint/surgery , Wrist Joint/surgeryABSTRACT
The Stanmore hinged total knee replacement was introduced in 1969 for severe destructive arthropathy of the knee, and the results of one hundred consecutive operations are presented after an average interval of two and a half years. Insertion of the prosthesis relieved pain in 94 per cent, improved the range of movement in 67 per cent, invariably restored stability and corrected valgus or varus deformity. Gross flexion contractures were improved but not always fully corrected. Serious complications were few, though of three cases of deep infection two came to amputation and one to fibrous ankylosis. There were no mechanical failures of components of the prosthesis.
Subject(s)
Arthroplasty , Joint Prosthesis , Knee Joint/surgery , Aged , Arthritis, Rheumatoid/rehabilitation , Arthritis, Rheumatoid/surgery , Female , Humans , Male , Middle Aged , Osteoarthritis/rehabilitation , Osteoarthritis/surgery , Pain/surgery , Postoperative Complications , Prosthesis DesignSubject(s)
Femur Neck , Hip/surgery , Joint Prosthesis/adverse effects , Biocompatible Materials , Humans , Metallurgy , Quality of Health CareSubject(s)
Arthritis, Rheumatoid/surgery , Joint Prosthesis , Shoulder Joint/surgery , Adult , Chromium , Cobalt , Female , Humans , Male , Middle Aged , Radiography , Shoulder/diagnostic imagingABSTRACT
A pilot study has shown that there is usually but not invariably a fall in systemic arterial blood pressure within 90 seconds of implanting acrylic cement into the femoral shaft during hip arthroplasty. There is usually no change in arterial blood pressure on implanting acrylic cement into the acetabulum. The observed hypotension may be due to absorption of monomer or additives into the circulation, but the role of other factors needs investigation.