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Radionuclide imaging of the painful joint replacement: past, present and future

Palestro,Christopher
Fonte: Instituto de Tecnologia do Paraná - Tecpar Publicador: Instituto de Tecnologia do Paraná - Tecpar
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/09/2002 EN
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576.72766%
Differentiating aseptic loosening from infection as the cause of prosthetic joint failure is difficult because both entities are similar, clinically and histopathologically. Aseptic loosening frequently results from an immune reaction to the prosthesis. There is inflammation with an influx of histiocytes, giant cells, lymphocytes, and plasma cells. Proinflammatory cytokines and proteolytic enzymes are secreted, causing osteolysis and loosening. These same events occur in infection except that neutrophils, rarely present in aseptic loosening, are invariably present in infection. Clinical signs and symptoms, laboratory tests, x-rays and joint aspiration are insensitive, nonspecific or both. Artifacts produced by the metallic hardware hamper cross-sectional imaging modalities. Radionuclide imaging is not affected by the presence of metallic hardware and is very useful for evaluating the painful prosthesis. Bone scintigraphy, with an accuracy of 50%-70% is a useful screening test, since a normal study effectively excludes a prosthetic complication. Adding gallium-67, a nonspecific inflammation-imaging agent, improves the accuracy of bone scintigraphy to 70%-80%. The accuracy of combined leukocyte/marrow imaging, 90%, is the highest among available radionuclide studies. Its success is due to the fact that leukocyte imaging is most sensitive for detecting neutrophil mediated inflammations. Inflammatory conditions that are neutrophil-poor...

The Australian Orthopaedic Association National Joint Replacement Registry

Graves, S.; Davidson, D.; Ingerson, L.; Ryan, P.; Griffith, E.; McDermott, B.; Pratt, N.
Fonte: Australasian Med Publ Co Ltd Publicador: Australasian Med Publ Co Ltd
Tipo: Artigo de Revista Científica
Publicado em //2004 EN
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In the financial year ending June 2002, 26 689 hip replacements and 26089 knee replacements (total, 52778) were performed in Australia. Hip and knee replacement procedures have increased between 5%-10% each year for the past 10 years, with a combined increase in hip and knee replacement of 13.4% in the past year. The revision rate for hip replacement surgery in Australia is unknown but is estimated to be 20%-24%; the revision rate for hip replacement surgery in Sweden is 7%. Although data collection for the Registry is voluntary, it has 100% compliance from hospitals undertaking joint-replacement surgery.; Stephen E Graves, David Davidson, Lisa Ingerson, Philip Ryan, Elizabeth C Griffith, Brian F J McDermott, Heather J McElroy and Nicole L Pratt; The document attached has been archived with permission from the editor of the Medical Journal of Australia. An external link to the publisher’s copy is included.

Ceramic-on-ceramic bearing surface and risk of revision due to dislocation after primary total hip replacement

Sexton, S.; Walter, W.; Jackson, M.; de Steiger, R.; Stanford, T.
Fonte: British Editorial Soc Bone Joint Surgery Publicador: British Editorial Soc Bone Joint Surgery
Tipo: Artigo de Revista Científica
Publicado em //2009 EN
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579.9903%
Dislocation is a common reason for revision following total hip replacement. This study investigated the relationship between the bearing surface and the risk of revision due to dislocation. It was based on 110 239 primary total hip replacements with a diagnosis of osteoarthritis collected by the Australian Orthopaedic Association National Joint Replacement Registry between September 1999 and December 2007. A total of 862 (0.78%) were revised because of dislocation. Ceramic-on-ceramic bearing surfaces had a lower risk of requiring revision due to dislocation than did metal-on-polyethylene and ceramic-on-polyethylene surfaces, with a follow-up of up to seven years. However, ceramic-on-ceramic implants were more likely to have larger prosthetic heads and to have been implanted in younger patients. The size of the head of the femoral component and age are known to be independent predictors of dislocation. Therefore, the outcomes were stratified by the size of the head and age. There is a significantly higher rate of revision for dislocation in ceramic-on-ceramic bearing surfaces than in metal-on-polyethylene implants when smaller sizes (< or = 28 mm) of the head were used in younger patients (< 65 years) (hazard ratio = 1.53, p = 0.041) and also with larger (> 28 mm) and in older patients (> or = 65 years) (hazard ratio = 1.73...

Poor outcome of revised resurfacing hip arthroplasty: 397 cases from the Australian Joint Replacement Registry

de Steiger, R.; Miller, L.; Prosser, G.; Graves, S.; Davidson, D.; Stanford, T.
Fonte: Taylor & Francis Publicador: Taylor & Francis
Tipo: Artigo de Revista Científica
Publicado em //2010 EN
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Background and purpose: Recent years have seen a rapid increase in the use of resurfacing hip arthroplasty despite the lack of literature on the long-term outcome. In particular, there is little evidence regarding the outcome of revisions of primary resurfacing. The purpose of this analysis was to examine the survivorship of primary resurfacing hip arthroplasties that have been revised. Patients and methods: Over 12,000 primary resurfacing hip arthroplasties were recorded by the Australian Orthopaedic Association National Joint Replacement Registry between September 1, 1999 and December 31, 2008. During this time, 397 revisions for reasons other than infection were reported for these primary resurfacings and classified as acetabular, femoral, or both acetabular and femoral revisions. The survivorship of the different types of revisions was estimated using the Kaplan-Meier method and compared using proportional hazard models. Additionally, the outcome of a femoral-only revision was compared to that of primary conventional total hip arthroplasty. Results: Acetabular-only revision had a high risk of re-revision compared to femoral-only and both acetabular and femoral revision (5-year cumulative per cent revision of 20%, 7%, and 5% respectively). Femoral-only revision had a risk of re-revision similar to that of revision of both the acetabular and femoral components. Femoral-only revision had over twice the risk of revision of primary conventional total hip arthroplasty. Interpretation: Revision of a primary resurfacing arthroplasty is associated with a major risk of re-revision. The best outcome is achieved when either the femoral-only or both the acetabular and femoral components are revised. Technically straightforward femoral-only revisions generally have a worse outcome than a primary conventional total hip arthroplasty.; Richard N. de Steiger...

Outcome of revision of unicompartmental knee replacement: 1,948 cases from the Australian Orthopaedic Association National Joint Replacement Registry, 1999-2008

Hang, J.; Stanford, T.; Graves, S.; Davidson, D.; de Steiger, R.; Miller, L.
Fonte: Taylor & Francis Publicador: Taylor & Francis
Tipo: Artigo de Revista Científica
Publicado em //2010 EN
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575.3559%
Background and purpose: Despite concerns regarding a higher risk of revision, unicompartmental knee arthroplasty (UKA) continues to be used as an alternative to total knee arthroplasty (TKA). There are, however, limited data on the subsequent outcome when a UKA is revised. We examined the survivorship for primary UKA procedures that have been revised. Methods: We used data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) to analyze the survivorship of 1,948 revisions of primary UKA reported to the Registry between September 1999 and December 2008. This was compared to the results of revisions of primary TKA reported during the same period where both the femoral and tibial components were revised. The Kaplan-Meier method for modeling survivorship was used. Results: When a primary UKA was revised to another UKA (both major and minor revisions), it had a cumulative per cent revision (CPR) of 28 and 30 at 3 years, respectively. The CPR at 3 years when a UKA was converted to a TKA was 10. This is similar to the 3-year CPR (12) found earlier for primary TKA where both the femoral and tibial components were revised. Interpretation: When a UKA requires revision, the best outcome is achieved when it is converted to a TKA. This procedure does...

Early outcomes of patella resurfacing in total knee arthroplasty: A report from the Australian Orthopaedic Association National Joint Replacement Registry

Clements, W.; Miller, L.; Whitehouse, S.; Graves, S.; Ryan, P.; Crawford, R.
Fonte: Taylor & Francis Publicador: Taylor & Francis
Tipo: Artigo de Revista Científica
Publicado em //2010 EN
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572.29055%
BACKGROUND: Patella resurfacing in total knee arthroplasty is a contentious issue. The literature suggests that resurfacing of the patella is based on surgeon preference, and little is known about the role and timing of resurfacing and how this affects outcomes. METHODS: We analyzed 134,799 total knee arthroplasties using data from the Australian Orthopaedic Association National Joint Replacement Registry. Hazards ratios (HRs) were used to compare rates of early revision between patella resurfacing at the primary procedure (the resurfacing group, R) and primary arthroplasty without resurfacing (no-resurfacing group, NR). We also analyzed the outcomes of NR that were revised for isolated patella addition. RESULTS: At 5 years, the R group showed a lower revision rate than the NR group: cumulative per cent revision (CPR) 3.1% and 4.0%, respectively (HR = 0.75, p < 0.001). Revisions for patellofemoral pain were more common in the NR group (17%) than in the R group (1%), and "patella only" revisions were more common in the NR group (29%) than in the R group (6%). Non-resurfaced knees revised for isolated patella addition had a higher revision rate than patella resurfacing at the primary procedure, with a 4-year CPR of 15% and 2.8%, respectively (HR = 4.1...

Duration of the Increase in Early Postoperative Mortality After Elective Hip and Knee Replacement

Lie, S.; Pratt, N.; Ryan, P.; Engesaeter, L.; Havelin, L.; Furnes, O.; Graves, S.
Fonte: Journal Bone Joint Surgery Inc Publicador: Journal Bone Joint Surgery Inc
Tipo: Artigo de Revista Científica
Publicado em //2010 EN
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585.58793%
BACKGROUND: There is increased early postoperative mortality after elective joint replacement surgery. However, the magnitude and duration of the increased mortality are uncertain. METHODS: Data on total knee and total hip replacement from the comprehensive national registries in Australia and Norway were assessed. Only patients between fifty and eighty years of age with osteoarthritis were included. Overall, the study included 81,856 patients with a total knee replacement and 106,254 patients with a total hip replacement. Smoothed intensity curves were calculated to show the change in mortality for the early postoperative period, whereas the effects of risk factors were studied with use of the nonparametric additive Aalen model. RESULTS: We found that early postoperative mortality was increased for the first twenty-six postoperative days (95% confidence interval, twenty-two to forty-one days). The excess mortality, compared with a baseline mortality (calculated as the average mortality from Day 100 to Day 200), for these twenty-six days was estimated to be 0.12% (95% confidence interval, 0.11% to 0.14%). The most important risk factors for excessive early postoperative mortality were male sex and high age (more than seventy years of age). CONCLUSIONS: There is an increased...

Smoking, body weight, physical exercise, and risk of lower limb total joint replacement in a population-based cohort of men

Mnatzaganian, G.; Ryan, P.; Norman, P.; Davidson, D.; Hiller, J.
Fonte: Wiley-Liss Publicador: Wiley-Liss
Tipo: Artigo de Revista Científica
Publicado em //2011 EN
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572.29055%
Objective. To assess the associations of smoking, body weight, and physical activity with risk of undergoing total joint replacement (TJR) in a population-based cohort of men. Methods. A cohort study of 11,388 men that integrated clinical data with hospital morbidity data and mortality records was undertaken. The risk of undergoing TJR was modeled on baseline weight, height, comorbidity, socioeconomic status, years of smoking, and exercise in 3 separate age groups, using Cox proportional hazards regressions and competing risk regressions (CRRs). Results. Dose-response relationships between weight and risk of TJR and between smoking and risk of TJR were observed. Being overweight independently increased the risk of TJR, while smoking lowered the risk. The decreased risk among smokers was demonstrated in both Cox and CRR models and became apparent after 23 years of exposure. Men who were in the highest quartile (>48 years of smoking) were 42–51% less likely to undergo TJR than men who had never smoked. Tests for trend in the log hazard ratios (HRs) across both smoking and weight quantiles yielded significant P values. Vigorous exercise increased the hazard of TJR; however, the association reached statistical significance only in the 70–74-year-old age group (adjusted HR 1.64 [95% confidence interval 1.19–2.24]). Adjusting for Deyo-Charlson Index or Elixhauser’s comorbidity measures did not eliminate these associations. Conclusion. Our findings indicate that being overweight and reporting vigorous physical activity increase the risk of TJR. This study is the first to demonstrate a strong inverse dose-response relationship between duration of smoking and risk of TJR. More research is needed to better understand the role of smoking in the pathogenesis of osteoarthritis.; George Mnatzaganian...

Is physical activity a risk factor for primary knee or hip replacement due to osteoarthritis? A prospective cohort study

Wang, Yuanyuan; Simpson, Julie Anne; Wluka, Anita E.; Teichtahl, Andrew J.; English, Dallas R.; Giles, Graham G.; Graves, Stephen Ellis; Cicuttini, Flavia M.
Fonte: J Rheumatol Publ Co Publicador: J Rheumatol Publ Co
Tipo: Artigo de Revista Científica
Publicado em //2011 EN
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Objective. To estimate prospectively any association between measures of physical activity and the risk of either primary knee or hip replacement due to osteoarthritis (OA). Methods. Eligible subjects (n = 39,023) were selected from participants in a prospective cohort study recruited 1990–1994. Primary knee and hip replacement for OA during 2001–2005 was determined by linking the cohort records to the National Joint Replacement Registry. A total physical activity level was computed, incorporating both intensity and frequency for different forms of physical activity obtained by questionnaire at baseline attendance. Results. There was a dose-response relationship between total physical activity level and the risk of primary knee replacement [hazards ratio (HR) 1.04, 95% CI 1.01–1.07 for an increase of 1 level in total physical activity]. Although vigorous activity frequency was associated with an increased risk of primary knee replacement (HR 1.42, 95% CI 1.08–1.86) for 1–2 times/week and HR 1.24 (95% CI 0.90–1.71) for ≥ 3 times/week), the p for trend was marginal (continuous HR 1.08, 95% CI 1.00–1.16, p = 0.05). The frequency of less vigorous activity or walking was not associated with the risk of primary knee replacement...

Five-year results of the ASR XL acetabular system and the ASR hip resurfacing system: An analysis from the Australian Orthopaedic Association National Joint Replacement Registry

de Steiger, R.; Hang, J.; Miller, L.; Graves, S.; Davidson, D.
Fonte: Journal Bone Joint Surgery Inc Publicador: Journal Bone Joint Surgery Inc
Tipo: Artigo de Revista Científica
Publicado em //2011 EN
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BACKGROUND: Articular Surface Replacement (ASR) hip prostheses, which have metal-on-metal bearing surfaces, were manufactured by DePuy Orthopaedics (Warsaw, Indiana) for use in both conventional total hip arthroplasty and hip resurfacing. Both the ASR XL Acetabular System and the ASR Hip Resurfacing System were recently recalled worldwide by the manufacturer. This report summarizes an analysis by the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) of the outcome of arthroplasties involving the ASR prostheses. METHODS: The first recorded use of the ASR XL Acetabular System in Australia occurred in 2004, and the Registry recorded 4406 procedures involving this system through December 31, 2009. The first recorded use of the ASR Hip Resurfacing System in Australia occurred in 2003, and the Registry recorded 1167 procedures through December 31, 2009. The Kaplan-Meier method and proportional-hazard modeling were used to compare the revision rate of primary total hip arthroplasties involving the ASR XL Acetabular System with that of arthroplasties involving all other conventional prostheses as well as with that of arthroplasties involving all other conventional prostheses with a metal-on-metal-articulation. In addition...

Cross-sectional analysis of association between socioeconomic status and utilization of primary total hip joint replacements 2006-7: Australian Orthopaedic Association National Joint Replacement Registry

Brennan, S.; Stanford, T.; Wluka, A.; Henry, M.; Page, R.; Graves, S.; Kotowicz, M.; Nicholson, G.; Pasco, J.
Fonte: BioMed Central Ltd. Publicador: BioMed Central Ltd.
Tipo: Artigo de Revista Científica
Publicado em //2012 EN
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Methods: Using the Australian Orthopaedic Association National Joint Replacement Registry data for 2006–7, primary THR with a diagnosis of osteoarthritis (OA) among residents of the BSD was ascertained. The Index of Relative Socioeconomic Disadvantage was used to measure SES; determined by matching residential addresses with Australian Bureau of Statistics census data. The data were categorised into quintiles; quintile 1 indicating the most disadvantaged. Age- and sex-specific rates of primary THR per 1,000 person years were reported for 10-year age bands using the total population at risk. Results: Females accounted for 46.9% of the 642 primary THR performed during 2006–7. THR utilization per 1,000 person years was 1.9 for males and 1.5 for females. The highest utilization of primary THR was observed in those aged 70–79 years (males 6.1, and females 5.4 per 1,000 person years). Overall, the U-shaped pattern of THR across SES gave the appearance of bimodality for both males and females, whereby rates were greater for both the most disadvantaged and least disadvantaged groups. Conclusions: Further work on a larger scale is required to determine whether relationships between SES and THR utilization for the diagnosis of OA is attributable to lifestyle factors related to SES...

Length of stay in hospital and all-cause readmission following elective total joint replacement in elderly men

Mnatzaganian, G.; Ryan, P.; Norman, P.; Davidson, D.; Hiller, J.
Fonte: Dove Medical Press Ltd Publicador: Dove Medical Press Ltd
Tipo: Artigo de Revista Científica
Publicado em //2012 EN
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Background: We retrospectively assessed the independent effects of patient and clinical factors on length of stay and all-cause 90-day, one-year, and two-year readmission following elective total joint replacement. We also evaluated the independent association between length of stay and readmission with postoperative five-year mortality. Methods: Longitudinal data from 819 men who had had total joint replacement were integrated with validated hospital morbidity data and mortality records. Length of stay, readmission, and mortality following total joint replacement were each modeled using multivariable proportional hazards regression. Results: Mean age at surgery was 76.3 ± 4.3 years. Median length of stay following total joint replacement decreased by 25% from 12 days in 1997–1998 to nine days in 2005–2007. Age, inhospital complications, total knee replacement, private hospital, and increased body weight were significantly associated with longer stay. A dose-response relationship between weight and length of stay was observed (P = 0.003). Crude 90-day, one-year, and two-year readmission rates were 17.3%, 47.4%, and 65.0%, respectively. Ninety-day readmission was associated with comorbidity, inhospital complications, and treatment in public hospitals. Age...

Total joint replacement in men: old age, obesity and in-hospital complications

Mnatzaganian, G.; Ryan, P.; Norman, P.; Davidson, D.; Hiller, J.
Fonte: Blackwell Science Asia Publicador: Blackwell Science Asia
Tipo: Artigo de Revista Científica
Publicado em //2013 EN
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BACKGROUND: We assessed risks of incident in-hospital complications and 1-year and 5-year mortality following elective primary total joint replacement (TJR), focusing on obesity. METHODS: Longitudinal data from a population-based cohort of 819 men who had had TJR were integrated with validated hospital morbidity data and mortality records. Complications recorded in the index admission were classified as major or minor by 13 independent orthopaedic surgeons. RESULTS: Of 819 men (mean age 76.3 (SD 4.5) years), 331 patients (40.4%) had an in-hospital complication from whom 155 (18.9%) had at least one major complication that was classified as potentially life threatening. Obesity and age were independently associated with increased risk of major complications. Compared with patients without complications, those with major complications experienced significantly greater mortality in 1 year (5.8% versus 1.2%, P = 0.001) and 5 years (16.8% versus 8.0%, P = 0.002) following TJR. In Cox regressions, age, Charlson Co-morbidity index and major complications were independently associated with 1-year mortality. Age and Charlson Co-morbidity index were also associated with 5-year mortality. Similarly, risk of dying within 5 years of TJR was higher among patients with class II obesity compared with patients with normal weight. The most frequently reported complications were those in the cardio-respiratory and general systems. Complications in the cardio-respiratory system significantly increased hazard of 1- and 5-year mortality. CONCLUSION: The elderly and the obese are more likely to develop adverse outcomes following a primary TJR. Our findings may assist clinicians in better selecting elderly patients for surgery...

Smoking and primary total hip or knee replacement due to osteoarthritis in 54,288 elderly men and women

Mnatzaganian, G.; Ryan, P.; Reid, C.; Davidson, D.; Hiller, J.
Fonte: BioMed Central Ltd. Publicador: BioMed Central Ltd.
Tipo: Artigo de Revista Científica
Publicado em //2013 EN
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BACKGROUND The reported association of smoking with risk of undergoing a total joint replacement (TJR) due to osteoarthritis (OA) is not consistent. We evaluated the independent association between smoking and primary TJR in a large cohort. METHODS The electronic records of 54,288 men and women, who were initially recruited for the Second Australian National Blood Pressure study, were linked to the Australian Orthopaedic Association National Joint Replacement Registry to detect total hip replacement (THR) or total knee replacement (TKR) due to osteoarthritis. Competing risk regressions that accounted for the competing risk of death estimated the subhazard ratios for TJR. One-way and probabilistic sensitivity analyses were undertaken to represent uncertainty in the classification of smoking exposure and socioeconomic disadvantage scores. RESULTS An independent inverse association was found between smoking and risk of THR and TKR observed in both men and women. Compared to non-smokers, male and female smokers were respectively 40% and 30% less likely to undergo a TJR. This significant association persisted after controlling for age, co-morbidities, body mass index (BMI), physical exercise, and socioeconomic disadvantage. The overweight and obese were significantly more likely to undergo TJR compared to those with normal weight. A dose–response relationship between BMI and TJR was observed (P < 0.001). Socioeconomic status was not independently associated with risk of either THR or TKR. CONCLUSION The strengths of the inverse association between smoking and TJR...

International comparative evaluation of knee replacement with fixed or mobile non-posterior-stabilized implants

Namba, R.; Graves, S.; Robertsson, O.; Furnes, O.; Stea, S.; Puig-Verdié, L.; Hoeffel, D.; Cafri, G.; Paxton, E.; Sedrakyan, A.
Fonte: Journal of Bone and Joint Surgery Inc. Publicador: Journal of Bone and Joint Surgery Inc.
Tipo: Artigo de Revista Científica
Publicado em //2014 EN
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Background: Mobile-bearing total knee prostheses were designed to reduce wear and improve implant survivorship following total knee arthroplasty. However, the benefit of mobile-bearing total knee arthroplasty remains unproven. Both mobile-bearing and fixed-bearing total knee arthroplasty implants are available in posterior-stabilized and non-posterior-stabilized designs. With the latter, the implant does not recreate the function of the posterior cruciate ligament (PCL) with a posterior-stabilizing cam mechanism. The purpose of the present study was to compare mobile-bearing, non-posterior-stabilized devices with fixed-bearing, non-posterior-stabilized devices used in total knee arthroplasty through a novel multinational study design. Methods: Through the use of a distributed health data network, primary total knee arthroplasties performed for osteo-arthritis from 2001 to 2010 were identified from six national and regional total joint arthroplasty registries. Multivariate meta-analysis was performed with use of linear mixed models, with the primary outcome of interest being revision for any reason. Survival probabilities and their standard errors were extracted from each registry for each unique combination of the covariates. Results: A total of 319...

A simplified lateral hinge approach to the proximal interphalangeal joint

Bain, G.I.; McGuire, D.T.; McGrath, A.M.
Fonte: Wolters Kluwer Publicador: Wolters Kluwer
Tipo: Artigo de Revista Científica
Publicado em //2015 EN
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579.17793%
Proximal interphalangeal joint replacement is an effective treatment for painful arthritis affecting the joint. However, the complication rate is relatively high, with many of these complications related to soft-tissue imbalance or instability. Volar, dorsal, and lateral approaches have all been described with varying results. We describe a new simplified lateral hinge approach that splits the collateral ligament to provide adequate exposure of the joint. Following insertion of the prosthesis the collateral ligament is simply repaired, side-to-side, which stabilizes the joint. As the central slip, opposite collateral ligament, flexor and extensor tendons have not been violated, early active mobilization without splinting is possible, and the risk of instability, swan-neck, and boutonniere deformity are reduced. The indications, contraindications, surgical technique, and rehabilitation protocol are described.; Bain, Gregory I., McGuire, Duncan T., McGrath, Aleksandra M.

Use of routine hospital morbidity data together with weight and height of patients to predict in-hospital complications following total joint replacement

Mnatzaganian, G.; Ryan, P.; Norman, P.; Davidson, D.; Hiller, J.
Fonte: BioMed Central Ltd. Publicador: BioMed Central Ltd.
Tipo: Artigo de Revista Científica
Publicado em //2012 EN
Relevância na Pesquisa
579.9903%
BACKGROUND: Routinely collected data such as hospital morbidity data (HMD) are increasingly used in studying clinical outcomes among patients undergoing total joint replacement (TJR). These data are readily available and cover large populations. However, since these data were not originally collected for the purpose of health research, a rigorous assessment of their quality is required. We assessed the accuracy of the diagnosis of obesity in HMD and evaluated whether the augmentation of HMD with actual weight and height of patients could improve their ability to predict major in-hospital complications following total joint replacement in men. METHODS: The electronic records of 857 participants in the Health In Men Study (HIMS) who had had TJR were linked with Western Australia HMD. HMD-recorded diagnosis of obesity was validated using the actual weight and height obtained from HIMS. In-hospital major complications were modelled using multivariable logistic regressions that either included the actual weight and height or HMD-recorded obesity. Model discrimination was calculated using area under ROC curve. RESULTS: The HMD failed to detect 70% of the obese patients. Only 64 patients (7.5%) were recorded in HMD as obese although 216 (25%) were obese [BMI: ≥30kg/m2] (sensitivity: 0.2...

Using linked clinical and hospital morbidity data to assess risk and outcomes of primary lower limb total joint replacement in elderly men.

Mnatzaganian, George
Fonte: Universidade de Adelaide Publicador: Universidade de Adelaide
Tipo: Tese de Doutorado
Publicado em //2012
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Background: Osteoarthritis is the most common musculoskeletal disorder affecting elderly Australians and is a leading cause of lower limb total joint replacement (TJR). The incidence of TJR has risen substantially over the past two decades, reflecting the ageing population, and increases in the prevalence of risk factors such as obesity. Primary TJR is considered to be relatively safe with low rates of adverse outcomes, however, there is increasing evidence that elderly, and male patients who undergo the procedure may be at higher risk for postoperative complications and mortality. The retrospective cohort studies presented in this thesis used data, drawn from Health In Men Study (HIMS), that were linked with Western Australia (WA) linked data system to assess risk and outcomes of primary TJR in a large population-based cohort of men. The studies closely examined three issues - obesity, co-morbidities, and smoking - about which there is continuing debate in regard to their association with the risk of undergoing the procedure, and their roles as determinants of outcome of TJR. These risk factors are particularly important because they are amenable to modification. Objectives: The main objectives of this thesis were: 1. To validate WA hospital morbidity data (HMD) and to assess the performance of HMD-based co-morbidity adjustment methods in predicting mortality among men undergoing elective primary TJR. 2. To assess risk of undergoing elective primary TJR in elderly men. 3. To assess risk of adverse outcomes following elective primary TJR including: • in-hospital complications...

The role of polyethylene wear in joint replacement failure

McGee, M.; Howie, D.; Neale, S.; Haynes, D.; Pearcy, M.
Fonte: Institution of Mechanical Engineers Publicador: Institution of Mechanical Engineers
Tipo: Artigo de Revista Científica
Publicado em //1997 EN
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682.8423%
Aseptic loosening is the major cause of failure of joint replacement prostheses. Polyethylene implants removed at revision regularly show wear. It is proposed that the polyethylene particles released into the tissues as a consequence of this wear induce a tissue response that precedes aseptic loosening. This paper presents the results of recent invivo and inviro studies of the biological response to polyethylene wear particles undertaken in the authors' laboratories. A clinical perspective is provided by the inclusion of the author's recent observations of retrieval analyses of joint replacement implant wear and the tissue response to polyethylene in humans.; M A McGee, D W Howie, S D Neale, D R Haynes and M J Pearcy

The role of custom-made prosthesis for temporomandibular joint replacement

Mercuri,Louis G.
Fonte: Revista Española de Cirugía Oral y Maxilofacial Publicador: Revista Española de Cirugía Oral y Maxilofacial
Tipo: info:eu-repo/semantics/article; journal article; info:eu-repo/semantics/publishedVersion Formato: text/html; application/pdf
Publicado em 01/03/2013 ENG
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Alloplastic temporomandibular joint replacement (TMJ TJR) presents unique problems due to the integral and multifaceted roles this joint plays within the stomatognathic system to establish and maintain appropriate mandibular function and form. The TMJ not only acts as a secondary mandibular growth center pre-puberty, but is also crucial in maintaining proper mastication, speech, airway support and deglutition. Further, these essential life functions place the TMJ under more cyclical loading and unloading than any other body joint over a lifetime. Therefore, when TMJ TJR is indicated the device chosen must be able to provide long-term mandibular function and form outcomes. End-stage TMJ pathology accompanied by physiological function and anatomical form distortions dictates the need for replacement. Due to the complex nature of joint related masticatory muscle functional and anatomical associations, it is unreasonable to expect an autogenous reconstructed TMJ or an alloplastic replaced TMJ can be returned to "normal" pre-morbid function. Therefore, as is understood with any orthopaedic joint replacement, patient and surgeon must agree and accept that there will always be some functional disability involved with any reconstructed or replaced TMJ. Further...