Subject(s)
Equipment Contamination , Infection Control , Joint Prosthesis , Anti-Bacterial Agents/economics , Anti-Bacterial Agents/therapeutic use , Equipment Contamination/economics , Equipment Contamination/prevention & control , Humans , Infection Control/economics , Infection Control/methods , Infections/drug therapy , Infections/economics , Infections/etiology , Joint Prosthesis/microbiologyABSTRACT
BACKGROUND: Although a minimally invasive total knee arthroplasty (MIS-TKA)fails to show superior short-term clinical results over a standard technique, the longer-term outcomes remain unknown. OBJECTIVE: Evaluate the intermediate clinical outcomes of MIS-TKA, comparing to those of standard technique. MATERIAL AND METHOD: The authors retrospectively collected data from the patients who underwent uncomplicated total knee arthroplasty between March 2004 and December 2005. Patients with a body mass index (BMI) over 30 kg/m2 or with severe deformity and those who required a complex surgical procedure were excluded. Patients were divided into 2 groups based on the surgical approach: 27patients (31 knees) and 26 patients (33 knees) for the MIS-TKA and standard TKA, respectively. Pre- and perioperative data were collected. Clinical and functional outcomes were followed-up to a minimum of 5 years. RESULTS: The means follow-up in the MIS- and standard TKA groups were 73 and 74 months, respectively. Pre- and perioperative data did not show any differences between the two groups except for more females and lower BMI in the MIS-TKA group. At 2- and 5-year post-operative follow-up, the knee society pain and functional scores improved significantly in both groups (p < 0.001). There were no differences in the postoperative alignment, range of motion and the knee society scores between MIS- and standard TKA. In addition, post-operative complications were similar in both groups (2 manipulations under anesthesia and 1 traumatic rupture of patellar tendon in each group). CONCLUSION: The present study showed that there were no differences in the intermediate-term post-operative function between MIS-TKA and standard TKA in a well-selected patient population. Thus, orthopedic surgeons should not compromise their surgical exposure by using small and unfamiliar surgical technique. Since MIS-technique may increase the postoperative complication rate, a long-term study to evaluate the results of MIS-TKA is still needed.
Subject(s)
Arthroplasty, Replacement, Knee/methods , Aged , Female , Humans , Male , Minimally Invasive Surgical Procedures , Postoperative Complications , Treatment OutcomeABSTRACT
The clinical results of semiconstrained total elbow arthroplasty have been encouraging, especially in rheumatoid arthritis. This article presents medium-term clinical results, revision rates, and reasons for revision of a semiconstrained linked total elbow device (Solar Total Elbow; Stryker, Mahwah, New Jersey). We retrospectively reviewed 17 consecutive total elbow arthroplasty patients operated on between February 1994 and March 2001. Thirteen patients were available for clinical evaluation with an average follow-up of 8.4 years (range, 4-12.6 years). The presenting diagnosis was posttraumatic arthritis in 6 patients, rheumatoid arthritis in 6, and gouty arthritis in 1, with an average patient age of 63.4 years. The results were analyzed with regard to complications following the procedure, functional outcome using the Mayo Elbow Performance Score (MEPS), and radiological evaluation at latest follow-up. The mean MEPS improved from 32.1 to 65 at latest follow-up. Three patients had excellent results, 5 had good results, 1 had a fair result, and 4 had poor results. Seven patients required at least 1 revision surgery, including 2 with humeral component loosening, 2 with ulnar component loosening, and 2 with bushing failure. One patient required resection arthroplasty for deep periprosthetic infection. Three patients eventually sustained periprosthetic fractures. Five patients with rheumatoid arthritis and 2 patients with posttraumatic arthritis underwent revision surgery. Poor clinical outcomes and a high revision rate were noted in patients with posttraumatic arthritis. Further comparative studies with other semiconstrained devices are necessary to determine their clinical effectiveness in patients with rheumatoid arthritis.
Subject(s)
Arthritis, Rheumatoid/surgery , Arthroplasty/instrumentation , Arthroplasty/methods , Elbow Joint/surgery , Joint Prosthesis , Prosthesis Failure , Female , Humans , Male , Middle Aged , Reoperation , Retrospective Studies , Treatment OutcomeABSTRACT
OBJECTIVE: To identify the genetic abnormality responsible for osteoarthritis (OA), avascular necrosis (AVN) of the femoral head, and Legg-Calvé-Perthes disease in a single family, and to determine factors responsible for the distinct phenotypes manifested by different family members. METHODS: Forty-two members of a 5-generation family were recruited and investigated. Diagnosis was made by independent orthopedic surgeons and radiologists. Histopathologic changes of the diseased tissue were examined. Linkage analysis was performed with markers spanning the COL2A1 locus. Haplotypes were constructed and mutation of the gene was detected. Structures of the wild-type and mutant proteins were modeled. RESULTS: Sixteen affected members were identified (5 with isolated precocious hip OA, 6 with AVN of the femoral head, and 5 with Legg-Calvé-Perthes disease). A p.Gly1170Ser mutation of COL2A1 cosegregated with the 3 diseases and was absent in controls. Of note, age at onset in relation to the closure status of the femoral head epiphysis was associated with the diseases, with Legg-Calvé-Perthes disease presenting prior to closure (at ages 6-14 years), AVN of the femoral head presenting during closure (at ages 15-18 years), and precocious OA of the hip presenting after closure (at ages 21-34 years). Molecular modeling predicted that the serine-to-glycine substitution loosens the helical structure of the protein. CONCLUSION: The p.Gly1170Ser mutation of COL2A1 in the family described is responsible for pathology confined to the hip joint, which presents as isolated precocious hip OA, AVN of the femoral head, or Legg-Calvé-Perthes disease. Age at onset in relation to closure of the femoral head epiphysis appears to be a critical factor in determining disease pattern.
Subject(s)
Collagen Type II/genetics , Femur Head Necrosis/genetics , Osteoarthritis, Hip/genetics , Polymorphism, Single Nucleotide/genetics , Adolescent , Adult , Aged , Case-Control Studies , Child , Cohort Studies , Epiphyses/growth & development , Epiphyses/physiopathology , Female , Femur Head Necrosis/physiopathology , Humans , Legg-Calve-Perthes Disease/genetics , Legg-Calve-Perthes Disease/physiopathology , Male , Middle Aged , Osteoarthritis, Hip/physiopathology , PedigreeABSTRACT
Pneumoccal infection of a total knee replacement is rare. We present a case of hematogeous pneumoccocal infection of a revision total knee arthroplasty as a complication of disseminated pneumoccocal sepsis. The patient was successfully treated with two stage reimplantation in addition to 8 weeks of intravenous moxifloxacin and penicillin, and remains infection free and functions well over 3 years postoperatively.
Subject(s)
Knee Prosthesis/microbiology , Pneumococcal Infections/complications , Prosthesis-Related Infections/microbiology , Sepsis/microbiology , Anti-Infective Agents/therapeutic use , Arthroplasty, Replacement, Knee , Aza Compounds/therapeutic use , Fluoroquinolones , Humans , Male , Middle Aged , Moxifloxacin , Penicillins/therapeutic use , Pneumococcal Infections/drug therapy , Prosthesis-Related Infections/drug therapy , Quinolines/therapeutic use , Reoperation , Sepsis/complications , Sepsis/drug therapyABSTRACT
UNLABELLED: Scar cosmesis is one of the proposed benefits of mini-incision total hip replacement as opposed to standard-incision procedures; however, there has been no scientific proof of this clinical outcome. The cosmetic appearances of healed incisions of 34 primary total hip replacement procedures done by one surgeon using either a mini-incision (20 procedures) or a standard-length incision (14 procedures) were compared at an average of 2 years postoperatively. Each scar's appearance was graded independently by two plastic surgeons using a standardized rating system. Patients answered a questionnaire regarding their subjective assessment of their scar. The blinded observers found that more mini-scars (six of 20) were rated poor than standard scars (one of 14) and that more standard-incision patients had scars that were rated good. More mini-incision patients (two of 20 versus zero of 14) had wound-healing problems. All the patients thought that their hip scar was acceptable in appearance, but 30 of 31 patients rated the relief of pain and total hip replacement longevity as higher priorities than scar cosmesis. The cosmesis of mini-incision total hip replacement scars may be inferior to standard-incision scars because of skin and soft tissue damage produced by high retractor pressures needed for exposure using a limited skin incision. LEVEL OF EVIDENCE: Therapeutic study, Level II-2 (prospective comparative study). See the Guidelines for Authors for a complete description of levels of evidence.
Subject(s)
Arthroplasty, Replacement, Hip/adverse effects , Cicatrix/etiology , Cicatrix/prevention & control , Cosmetic Techniques , Minimally Invasive Surgical Procedures/adverse effects , Adult , Aged , Aged, 80 and over , Arthroplasty, Replacement, Hip/instrumentation , Cicatrix/psychology , Female , Humans , Male , Middle Aged , Minimally Invasive Surgical Procedures/instrumentation , Patient Satisfaction , Postoperative Complications/etiology , Postoperative Complications/prevention & control , Postoperative Complications/psychology , Prospective Studies , Surgery, Plastic , Surgical Instruments , Surveys and QuestionnairesABSTRACT
BACKGROUND: Primary total hip replacement performed through an incision that is =10 cm in length has been advocated as a minimally invasive technique. Proponents have claimed that mini-incision techniques reduce blood loss, transfusion requirements, postoperative pain, and the length of the hospital stay compared with standard techniques through a longer incision. However, we are aware of no well-designed comparison study that supports these claims. The purpose of the present study was to compare the short-term results of a mini-incision with a standard incision technique for total hip replacement. METHODS: A consecutive series of patients who underwent 135 primary unilateral total hip replacements (fifty with use of a mini-incision [=10 cm] and eighty-five with use of a standard incision) by three surgeons at one hospital were studied. Each surgeon selected patients to have a mini-incision procedure and performed a standard approach in the remaining patients. A posterior approach was used for all procedures. In-hospital data were collected retrospectively, and the initial postoperative radiographs were analyzed. Because of the selection process, the patients who had a mini-incision had both a significantly lower average body-mass index (p = 0.008) and a lower average score on the American Society of Anesthesiologists rating (p = 0.006), indicating that they were thinner and healthier than the patients who had a standard incision. RESULTS: With the numbers of patients available, no significant differences were found between the groups with respect to the average surgical time, intraoperative blood loss, in-hospital transfusion rate, length of hospital stay, or the patients' disposition after discharge. The mini-incision group was found to have a significantly higher risk of a wound complication (p = 0.02), a higher percentage of acetabular component malposition (p = 0.04), and poor fit and fill of femoral components inserted without cement (p = 0.0036). CONCLUSIONS: There was no evidence that the mini-incision technique resulted in less bleeding or less trauma to the soft tissues of the hip, factors that would have produced a quicker recovery and a shorter hospital stay, than did the standard technique. The present study, which was based on the authors' initial experience with the mini-incision technique, failed to confirm the positive clinical outcomes reported by previous uncontrolled cohort studies, and the findings suggest that further analysis of this new technique is needed before it can be recommended for general use.
Subject(s)
Arthroplasty, Replacement, Hip/methods , Adult , Aged , Aged, 80 and over , Female , Hip Joint/diagnostic imaging , Hip Joint/surgery , Humans , Male , Middle Aged , Minimally Invasive Surgical Procedures , Radiography , Retrospective StudiesABSTRACT
OBJECTIVE: To evaluate the results of 36 unconstrained shoulder arthroplasties. METHODS: In the series, 24 total and 12 hemi-arthroplasties of the shoulders were performed with unconstrained shoulder prostheses in 29 patients who suffered from glenohumeral degenerative arthritis, rheumatoid arthritis, avascular necrosis and proximal fracture of humerus, respectively. Follow-up averaged 6.2 years. All patients were evaluated pre- and post-operatively using the rating system of the Society of American Shoulder and Elbow Surgeons which assesses the severity of pain, strength of muscles around shoulder, stability, range of motion and functional activities of daily living. Radiolucent line and migration of prostheses were observed postoperatively on X-rays. RESULTS: Postoperatively, the rate of pain relief was 91.3%, and active range of motion increased by 47 in forward flexion, 43 in abduction, 30 in external rotation, and 4 segments in internal rotation. Preoperatively the average points of 6 functional activities patients could perform was 0.8, and postoperatively 3.1. On postoperative X-ray, proximal migration of the humerus was seen in 8 shoulders, 6 of which had either a torn or absent rotator cuff. Radiolucent lines were seen around 1 humeral component and 9 glenoid components. One humeral and 2 glenoid components loosened. CONCLUSIONS: These results suggest that unconstrained shoulder arthroplasty is a satisfactory and safe technique.