replacement arthroplasty

To investigate the biomechanical, histochemical, and biologic ingrowth characteristics of two different lumbar disc prostheses-AcroFlex (DePuy-AcroMed) and the SB Charitè (DePuy-AcroMed)-for total disc replacement arthroplasty.

..However, early and midterm data have demonstrated that the Scandinavian Total Ankle Replacement (STAR) or Agility Total Ankle may be a reasonable alternative to an ankle joint fusion...

..There is a significant deprivation based gradient in rates. If current trends continue there would be almost 47 000 primary hip and 54 000 primary knee operations annually by 2010...

..It should be considered in the treatment of osteoarthritis with a massive tear of the cuff but should be reserved for elderly patients...

..Here we report data on the use of total ankle replacements and the revision rate in the Norwegian population over a 12-year period...

..Whether or not ankles can be replaced with reasonable safety has been the subject of debate. We present the results of a nationwide series of total ankle arthroplasties...

..However, to our knowledge, no study has focused exclusively on patients with the diagnosis of inflammatory joint disease or has provided a detailed analysis of the risk factors for failure...

..The procedure has a substantial potential to improve the condition of patients with severe shoulder dysfunction, at least in the short term...

..Results of the reverse prosthesis depend on the diagnosis and on the remaining cuff muscles, specifically the teres minor. Surgeons should be vigilant with regard to low-grade infection in revision surgery...

..A high degree of registration completeness is necessary in order to obtain unbiased and accurate register-based study results. We investigated the completeness of registration in the national Norwegian Arthroplasty Register (NAR)...

A retrospective review was conducted on 12 patients (mean age, 63 years) undergoing replacement arthroplasty with calcar grafting for humeral surgical neck nonunions...

..Three common situations include revision for implant loosening in the long-term followup of arthroplasties or implant failure in the context of limb-salvage surgery or femoral neck fracture...

..It was therefore the purpose of this study to evaluate the influence of fatty infiltration of the teres minor muscle on the clinical outcome after reverse total shoulder replacement...

..The purpose of the present study was to evaluate the clinical relevance of notching and to determine the anatomic and radiographic parameters that predispose to its occurrence...

..A systematic review of the literature addressing the intermediate and long-term outcomes of interest in total ankle arthroplasty and ankle arthrodesis was performed...

..TDR, nowadays, is an approved procedure. Proof that long-term results of TDR implantation in DDD are at least as good as fusion results is still missing...

..These became less common with experience of the operation. The radiological appearance of the interface of the tibial implant was significantly related to its operative fit and to the type of bioactive coating...

..The designs of total ankle prostheses have changed in recent years in order to give better performance. Only a few studies of these ankle prostheses have been published, however, and none on micromotion...

..An improved knowledge of comparative outcomes would be valuable in guiding implant selection...

..Overall, successful, long-term total disc arthroplasty requires a thorough understanding of biomaterials and how they can be used to achieve their desired goals...

..CONCLUSIONS: Different gender and racial subgroups focus on different concerns when considering TKR. These differences may contribute to gender and race/ethnicity disparity seen in TKR use...

..01). Despite meticulous attention to subscapularis repair, suboptimal return of function was found on clinical examination and assessment of activities of daily living...

..Especially striking is the near absence of component revision because of loosening or other mechanical factors. Periprosthetic humeral fractures are more common; the explanation for this warrants further study...

..However, long-term results are required before reverse shoulder arthroplasty can be recommended as a routine procedure in complex fractures of the upper humerus in the elderly...

..Thus, much basic information about elbow form and function is needed to improve the performance of total elbow prostheses...

..We recommend our method of arthrodesis in this group of patients. A higher rate of nonunion is associated with rheumatoid arthritis which should be treated differently...

..Great care must be exercised, and alternative methods of treatment considered, before either hemiarthroplasty or total shoulder arthroplasty is offered to patients aged 50 years or younger...

..The purpose of the present study was to evaluate the effects of etiology on the results of reverse total shoulder arthroplasty...

..An anterior revision approach carries significant risk and should only be performed by surgeons experienced in anterior lumbar surgery...

..There is, however, no systematic approach to the available scientific evidence allowing for a critical appraisal of their benefits and risks...

..Agility total ankle replacement is a viable and durable option for the treatment of ankle arthritis in selected patients...

..Although total disc replacements have been performed in Europe since the 1980s, this type of surgery is still new in the United States. The clinical performance of polyethylene in total disc replacements is still not well understood...

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..Accelerated deterioration of function of shoulder arthroplasties was not observed in our young patient population...

..However, documentation of the clinical results of the use of these prostheses is sparse. We reviewed the intermediate-term results of fifty-one consecutive Scandinavian Total Ankle Replacements (STAR)...

..Although joint replacement can restore function for arthritis patients with severe joint disease, this procedure has not been used equally across racial groups. Differences in joint replacement use are assessed from a national sample...

..We evaluated the ability of a group of experienced shoulder surgeons to achieve complete cementing and support in a series of patients managed with keeled and pegged glenoid components...

..There is a marked difference between black patients and white patients in the utilization of joint replacement therapy. The reasons behind this disparity remain unknown...

..The design features of the Arrow prosthesis--reduced medialisation of the center of rotation with lateralisation of the humerus--were found to be associated with slight improvement in range of motion and absence of scapular notching...

..However, glenoid loosening remained a serious problem, and transacromial approaches were complicated by failure of acromial fixation...

..0001) and with glenoid radiolucent lines (P < .0001). Positioning of the baseplate definitely influences scapular notching. High positioning of the baseplate and superior tilting must be avoided...

..To retrospectively compare the long-term results of cemented and uncemented surface replacement arthroplasties of the proximal interphalangeal (PIP) joint in a single surgeon's experience...

..HSA remains a satisfactory solution in specific cases. In the future, we need to optimize the designs of the glenoid implant and develop a better implantation technique to avoid the problems associated with glenoid replacement...

..1 (95% confidence interval 1.6 to 5.9) times higher with implants with Ti-HA porous coating. Care should be taken with ankle arthroplasty until more is known about the reasons for these severe osteolyses...

..Therefore, it is important that the radiologist be familiar with the normal and abnormal imaging appearances of this new prosthesis...

..Polyethylene (PE) has been used in total disc replacements (TDRs) in Europe since the 1980s. However, the extent of surface damage of PE, including rim fracture and wear, after long-term implantation remains poorly understood...

..Considerable efforts are underway to develop such therapies, to identify novel targets for therapeutic intervention, and to develop effective outcome measures...

Cementless surface replacement arthroplasty of the shoulder is designed to replace the damaged joint surfaces and restore normal anatomy with minimal resection of bone. We have used the Copeland shoulder arthroplasty for 14 years...

..Our findings support previous studies which suggested that total ankle replacement should be undertaken with extreme caution in the presence of marked varus or valgus deformity...

..Although initial animal studies are promising for the development of possible pharmacologic agents for the treatment and prevention of osteolysis, well controlled human trials are required...

..We evaluated the survival of different TEA designs and factors associated with survival using data from a nationwide arthroplasty register...

..Our registry, therefore, fails as an implant registry. We believe that compliance for data registration can only be ensured if dedicated data collection staff are employed to co-ordinate the data collection and collation process...

..These observations suggest that greater attention to achieving proper component position, postoperative motion, and in fracture cases, fixation of the tuberosities may lead to increased patient satisfaction after shoulder arthroplasty...

..Tibiotalocalcaneal arthrodesis fusion with compression screws has not been successful in our experience...

..Revision was undertaken in four patients for persistent pain relating to medial migration. With revision taken as the endpoint for survival after eight years, 92% were found to be still in situ...

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..If prosthetic overhang cannot be obtained, we suggest removing part of the infraglenoid tubercle...

..The occurrence of an osseous gap on pilar of scapula may lead to failure of this prosthesis. This gap remains a threath as it can progress and as such warrants a design alteration of the prosthesis...

..Shoulder arthroplasty should not be delayed once symptomatic osteoarthritis has been established and should be undertaken before failure of the cuff or erosion of the glenoid are present...

..Subtalar arthritis may continue to progress after total ankle replacement. Our results are similar to those published previously...

..Currently, a hindfoot fusion appears to be preferable to a revision total ankle replacement...

..The selected use of this semiconstrained implant in patients with instability and poor bone stock was hypothesized to provide inferior results compared with those in the published reports...

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..For most, instability, rotator cuff tear, and glenoid wear occur together, and this is a challenging problem to treat successfully...

..The pressfit design seems to have overcome the disadvantages of the previous screw fit prosthesis which had been reported to have complications related to metallosis around the titanium screw...

..4 and 9.6 at 30 months, and 9.5 and 10.0 at 36 months. The "ream and run" procedure can offer similar functional recovery to patients with total shoulder arthroplasty, although the time to recovery may be longer...

..25). There were no significant differences in clinical outcome or radiological changes between the first- and second-generation designs of implant for shoulder arthroplasty...

..The high potential for complications must be considered. We consider total elbow replacement to be an acceptable procedure in selected patients with reasonable expectations...

..Although functional gains were modest, restoration of the glenoid bone component allows implantation if deemed necessary...

..1% (95% confidence interval 61.1 to 93.3). Revision elbow arthroplasty using the Coonrad-Morrey implant provided satisfactory results but with complications occurring in 13 cases...

..This problem has hopefully been addressed by redesigning the humeral resection guide. Other complications included three cases of ulnar neuropathy (8.3%) and one of deep infection (2.8%)...

..However, high rates of complications were associated with glenoid and proximal humeral bone loss...

..Further improvement in implant design and fixation technique appears to be necessary for long-term success of cemented glenoid components...

..Metallosis, loosening and instability were significantly correlated. The survival rate of 82% at 54 months (SD = 7) is lower than that reported for non-constrained and semi-constrained prostheses in the literature...

..This article introduces the rationale and various implant types available for cervical TDR. Part 2 of this series reviews the results and complications of specific implant designs...

..An overview of the surgical procedure is provided, with technical tips and pitfalls included. Finally, a standard postoperative regime is described...

..05) in the NF group than in the MV and NV groups. These results fail to confirm that humeral component modularity is an important factor in the outcome of shoulder arthroplasty...

..Moreover, these results, compared with other studies, indicate that geometric and bone properties of the scapula may be more important factors in the success of shoulder arthroplasty than implant design...

..Failure of the ulnar component was found to be the main problem in relation to the loosening. Anterior transposition of the ulnar nerve had no influence on ulnar nerve paresthaesiae in these patients...

..Therefore, we reviewed the results of this procedure, the risk factors for an unsatisfactory outcome, and the rates of failure in our patients...

..This study shows that the unlinked Souter-Strathclyde total elbow arthroplasty can be considered for patients with osteoarthritis and gives good symptomatic relief and improvement in function...

..Abutment may cause major shear forces and therefore cause glenoid loosening. The value of articular surface mismatch is questionable because retrieved glenoids were worn to a conforming joint...

..The trapezial height must be sufficient. The authors reports the preliminary results of 64 Guepar prostheses, anatomical new design, implanted since 1995...

..The purpose of this study was to report the outcomes of glenohumeral arthrodesis in the setting of severe glenohumeral bone loss and deltoid muscle and rotator cuff insufficiency following failed prosthetic shoulder arthroplasty...

..The functional results showed a mean Toronto extremity salvage score of 73% of normal. Endoprosthetic replacement of the distal humerus and elbow is a satisfactory method of treating these rare tumours...

..The advantage of this component seems marginal, and its use has been discontinued...

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..LEVEL OF EVIDENCE: Level III, retrospective study. See the Guidelines for Authors for a complete description of levels of evidence...

..We reviewed our experience of shoulder arthroplasties in 48 patients (51 shoulders) with 60 months average follow-up (24-124)...

..Currently, the results associated with the Souter-Strathclyde total elbow prosthesis are comparable with the results associated with other prostheses, but loosening of the humeral component remains a concern...

..The results led us to conclude that anatomical prostheses are effective in the treatment of severe primary glenohumeral arthropathy...

..The follow-up care of these patients is very important, not only from the standpoint of compliance but also because any long-term problems must be recognized and treated before the implant is lost...

..For young and middle-aged patients with osteoarthritis, third-generation total shoulder replacement is a viable method of treatment with a low rate of complications and excellent results in the mid-term...

..Prosthetic arthroplasty, although technically challenging, effectively reduced pain and improved function in our series...

..Implants with a proven long-term record must represent the 'gold standard'. New or modified implants should only be used if they are part of a properly conducted clinical trial...

..In younger patients bipolar implants should be used in preference; the functional results attained with these are admittedly limited, but unlike the reverse implants they do not involve the risk of loosening of the metaglenoid...

..We recommend this technique in patients where the tuberosity fragments are large enough to allow fixation with screws, washers and a toothed plate...

..Additionally, variable immunologic responses induced by implant degradation products (i.e. lymphocyte response to metal ions and monocyte/macrophage response to particulate debris) will be correlated with the development of osteolysis ..

..This research will elucidate important mechanisms of particle-induced, chemokine-directed cell trafficking and suggest new treatment strategies. ..

..Furthermore, if proven efficacious, Ml could readily be applied to other chronically painful conditions (e.g. chronic back pain). ..

..As a result, patient pain, suffering and morbidity will be minimized. ..

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..In addition, by eliminating the need for cell culture expansion facilities and expertise, the cost of this approach should be considerably less thereby making cartilage repair more globally accessible. ..

..Furthermore, if proven efficacious, Ml could readily be applied to other chronically painful conditions (e.g. chronic back pain). ..

..The Program Director, Munro Peacock, M.D., was appointed in July 1987. The GCRC was ..

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..The proposed study is significant because modifiable factors identified at the patient-PCP level may be amenable to educational or behavioral intervention which could eradicate ethnic disparity. ..

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..This research will elucidate important mechanisms of particle-induced, chemokine-directed cell trafficking and suggest new treatment strategies. ..

..In addition, by eliminating the need for cell culture expansion facilities and expertise, the cost of this approach should be considerably less thereby making cartilage repair more globally accessible. ..

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..Our global hypothesis is that in vivo mechanical factors (exercise vs. cage activity vs. immobilization) will cause a change in the mechanical properties, composition, and organization of the healing insertion site. ..

..The proposed study is significant because modifiable factors identified at the patient-PCP level may be amenable to educational or behavioral intervention which could eradicate ethnic disparity. ..

..Three-dimensional rate of ulcer healing will be measured with stereophotography and computerized image analysis techniques. ..

..It is felt that these findings will have relevance to other important area of orthopedics, including fracture healing, and have significant potential to impact the care of patients. ..

..Thus, successful achievement of the proposed research will provide essential information on TDR implant performance and on clinical outcomes, which are needed for informed health care decisions. ..

..It is then proposed in this study to observe the potential to inject simvastatin into degenerative disc to retard the progression of degenerative disc disease and also help repair the aberrant tissues. ..

..This is key information for the clinical management of these patients and to advance public health efforts to improve quality of life among 48 million US adults having arthritis. ..

..The objective of Phase I is to demonstrate that the device restores normal spine biomechanics (range of motion and stiffness) and is durable in fatigue testing. ..

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..This is the first study to explore very elderly women's approach to decisions about screening mammography. ..

..The purpose of this proposed research is to examine the influence of mechanical degradation after implantation on the clinical performance of metal-backed acetabular components for total hip arthroplasty. ..

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..With these complementary approaches we hope to thereby arrive at a broad understanding of the gene patterns controlling both fetal and adult wound healing, and identify gene products/pathways critical to both. ..

..It will also further her long-term career goal to become a skilled and established independent investigator in the area of disease prevention and health promotion for the oldest-old. ..

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..This methodology can be readily extended to investigate and optimize the treatment of soft tissue injures of other articular joints such as the spine, shoulder, wrist and ankle. ..

..Our image technique will be further applicable to other soft tissue injuries such as cartilage defects and soft tissue defects in the shoulder, hip, wrist, ankle and spine. ..