The Journal of Bone & Joint Surgery最新文献

{"title":"Patellar Resurfacing in Total Knee Arthroplasty: A Prospective, Randomized Study","authors":"T. Waters, G. Bentley","doi":"10.2106/00004623-200312000-00039","DOIUrl":"https://doi.org/10.2106/00004623-200312000-00039","url":null,"abstract":"Background: Anterior knee pain following total knee arthroplasty is a common complaint and typically is attributed to the patellofemoral joint. The purpose of the present study was to compare the outcome of resurfacing and nonresurfacing of the patella, particularly with regard to anterior knee pain, and to clarify the indications for patellar resurfacing at the time of total knee arthroplasty.Methods: We performed a prospective, randomized study of 514 consecutive primary press-fit condylar total knee replacements. The patients were randomized to either resurfacing or retention of the patella. They were also randomized to either a cruciate-substituting or a cruciate-retaining prosthesis as part of a separate trial. The mean duration of follow-up was 5.3 years (range, two to 8.5 years), and the patients were assessed with use of the Knee Society rating, a clinical anterior knee pain score, and the British Orthopaedic Association patient-satisfaction score. The assessment was performed without the examiner knowing whether the patella had been resurfaced. At the time of follow-up, there were 474 knees. Thirty-five patients who had a bilateral knee replacement underwent resurfacing on one side only.Results: The overall prevalence of anterior knee pain was 25.1% (fifty-eight of 231 knees) in the nonresurfacing group, compared with 5.3% (thirteen of 243 knees) in the resurfacing group (p < 0.0001). There was one case of component loosening. Ten of eleven patients who underwent secondary resurfacing had complete relief of anterior knee pain. The overall postoperative knee scores were lower in the nonresurfacing group, and the difference was significant among patients with osteoarthritis (p < 0.01). There was no significant difference between the resurfacing and nonresurfacing groups with regard to the postoperative function score. Patients who had a bilateral knee replacement were more likely to prefer the resurfaced side.Conclusions: As the present study showed a significantly higher rate of anterior knee pain following arthroplasty without patellar resurfacing, we recommend patellar resurfacing at the time of total knee replacement when technically possible.Level of Evidence: Therapeutic study, Level I-1a (Randomized controlled trial [significant difference]). See Instructions to Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88878959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes After Lumbar Discectomy for Sciatica: The Effects of Fragment Type and Anular Competence","authors":"E. Carragee, Michael Han, Patrick W. Suen, David Kim","doi":"10.2106/00004623-200301000-00016","DOIUrl":"https://doi.org/10.2106/00004623-200301000-00016","url":null,"abstract":"Background: The surgical treatment of sciatica with discectomy is ineffective in a sizable percentage of patients, and reherniation occurs after 5% to 15% of such procedures. The purpose of the present study was to determine if competence of the disc anulus and the type of herniation could be used to predict postoperative clinical outcomes following lumbar discectomy.Methods: A prospective observational study of 187 consecutive patients undergoing single-level primary lumbar discectomy was conducted. A single surgeon performed all of the procedures, and an independent examiner evaluated 180 of the patients clinically at a minimum of two and a median of six years after surgery. The extent of anular deficiency and the presence of disc fragments were determined. On the basis of these intraoperative findings, disc herniations were classified into four categories: (1) Fragment-Fissure herniations (eighty-nine patients), (2) Fragment-Defect herniations (thirty-three patients), (3) Fragment-Contained herniations (forty-two patients), and (4) No Fragment-Contained herniations (sixteen patients). The effects of disc herniation morphology and preoperative variables on subsequent clinical outcome were determined with the Student t test for continuous variables and chi-square analysis for categorical variables.Results: Patients in the Fragment-Fissure group, who had disc fragments and a small anular defect, had the best overall outcomes and the lowest rates of reherniation (1%) and reoperation (1%). Patients in the Fragment-Contained group had a 10% rate of reherniation and a 5% rate of reoperation. Patients in the Fragment-Defect group, who had extruded fragments and massive posterior anular loss, had a 27% rate of reherniation and a 21% rate of reoperation. Patients in the No Fragment-Contained group did poorly: 38% had recurrent or persistent sciatica, and the standard outcomes scores were less improved compared with those in the other groups (p < 0.001).Conclusion: Intraoperative findings, as described in the present study, were more clearly associated with outcomes than were demographic, socioeconomic, or clinical variables. The degree of anular competence after discectomy and the type of herniation appear to have value for the prediction of the recurrence of sciatica, reoperation, and clinical outcome following lumbar discectomy.Level of Evidence: Prognostic study, Level I-1 (prospective study). See p. 2 for complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85018182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sustained Spinal Cord Compression: Part II: Effect of Methylprednisolone on Regional Blood Flow and Recovery of Somatosensory Evoked Potentials","authors":"G. Carlson, C. Gorden, S. Nakazawa, E. Wada, Jeremy S. Smith, J. LaManna","doi":"10.2106/00004623-200301000-00015","DOIUrl":"https://doi.org/10.2106/00004623-200301000-00015","url":null,"abstract":"Background: The efficacy of methylprednisolone in the treatment of traumatic spinal cord injury is controversial. We examined the effect of methylprednisolone on regional spinal cord blood flow and attempted to determine whether recovery of electrophysiological function is dependent on reperfusion, either during sustained spinal cord compression or after decompression.Methods: The effects of methylprednisolone therapy on recovery of somatosensory evoked potentials and on spinal cord blood flow were examined in a canine model of dynamic spinal cord compression. Methylprednisolone (30 mg/kg intravenous loading dose followed by 5.4 mg/kg/hr intravenous infusion) or saline solution was administered to thirty-six beagles (eighteen in each group) five minutes after cessation of dynamic spinal cord compression and loss of all somatosensory evoked potentials. After ninety minutes of sustained compression, the spinal cords were decompressed. Somatosensory evoked potentials and spinal cord blood flow were evaluated throughout the period of sustained compression and for three hours after decompression.Results: Seven dogs treated with methylprednisolone and none treated with saline solution recovered measurable somatosensory evoked potentials during sustained compression. After decompression, three more dogs treated with methylprednisolone and seven dogs treated with saline solution recovered somatosensory evoked potentials. Four dogs treated with methylprednisolone lost their previously measurable somatosensory evoked potentials. In the methylprednisolone group, spinal cord blood flow was significantly higher (p < 0.05) in the dogs that had recovered somatosensory evoked potentials than it was in the dogs that had not. Reperfusion blood flow was significantly higher (p < 0.05) in the saline-solution group than it was in the methylprednisolone group. Spinal cord blood flow in the saline-solution group returned to baseline levels within five minutes after decompression. It did not return to baseline levels in the dogs treated with methylprednisolone.Conclusions: The methylprednisolone administered in this study did not provide a large or significant lasting benefit with regard to neurological preservation or restoration. Methylprednisolone may reduce regional spinal cord blood flow through mechanisms affecting normal autoregulatory blood-flow function.Clinical Relevance: This study suggests that a major drawback of methylprednisolone therapy may be the reduction in regional spinal cord blood flow after decompression.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91237808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transitioning to Arthroscopic Rotator Cuff Repair: The Pros and Cons","authors":"K. Yamaguchi, W. Levine, G. Marra, L. Galatz, S. Klepps, E. Flatow","doi":"10.2106/00004623-200301000-00022","DOIUrl":"https://doi.org/10.2106/00004623-200301000-00022","url":null,"abstract":"There has been much recent enthusiasm regarding complete arthroscopic rotator cuff repair, and it is becoming apparent that, for many, this newer technique may be a preferable alternative to the more traditional mini-open rotator cuff repair. Several short-term studies have demonstrated that complete arthroscopic repair has excellent results comparable with those of mini-open repair, which is also an excellent technique. The choice of which procedure may be better for an individual patient or surgeon can be based on a variety of considerations, including the patient's expectations, the pathoanatomy of the cuff, and the surgical experience of the surgeon. The relative merits and disadvantages of arthroscopic rotator cuff repair are discussed on the basis of those considerations. When a surgeon is deciding which procedure to perform, it is important that the basic principles of rotator cuff repair not be compromised and that he or she perform the procedure that is most reproducible given his or her level of experience; however, for those who are now utilizing miniopen repair, arthroscopic repair may have important advantages and may be worth pursuing in the future. If a surgeon chooses to obtain the skills necessary to perform a complete arthroscopic repair, performance of the mini-open procedure offers an excellent opportunity to make an orderly transition.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78174262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Features of the Different Types of SLAP Lesions: An Analysis of One Hundred and Thirty-nine Cases","authors":"Tae Kyun Kim, W. S. Queale, A. Cosgarea, E. McFarland","doi":"10.2106/00004623-200301000-00011","DOIUrl":"https://doi.org/10.2106/00004623-200301000-00011","url":null,"abstract":"Background: Previous studies have suggested that SLAP (superior labrum anterior posterior) lesions are a distinct clinical entity. The goals of this study were to define the prevalence, associated pathological findings, and clinical features of the different types of SLAP lesions with use of a common classification system.Methods: Five hundred and forty-four patients undergoing shoulder arthroscopy for a variety of diagnoses were prospectively included in this consecutive case series. SLAP lesions were grouped with use of the Snyder classification. Demographic data, clinical data, and arthroscopic findings in the groups with SLAP lesions were compared with those in a control group with no SLAP lesion.Results: Of 544 shoulder arthroscopy procedures, 139 (26%) demonstrated a SLAP lesion. One hundred and three (74%) of the SLAP lesions were Type I, twenty-nine (21%) were Type II, one (0.7%) was Type III, and six (4%) were Type IV. Most (123) of the SLAP lesions were found to be associated with other intra-articular lesions. Multivariate analysis revealed that a positive Speed test and a supraspinatus tear were significantly associated with Type-I lesions (p = 0.012 and p = 0.001, respectively). The findings associated with Type-II lesions differed according to the patient's age: Type-II lesions in patients who were forty years of age or younger were associated only with a Bankart lesion, whereas those in patients older than forty years of age were associated with a supraspinatus tear and osteoarthritis of the humeral head. Type-III and Type-IV lesions were associated with a high-demand occupation and a Bankart lesion.Conclusions: This study demonstrated that the prevalence, associated pathological findings, and clinical features of the different types of SLAP lesions vary with the patient population that is studied. Also, the clinical features and pathological findings associated with the different types of SLAP lesions often overlap. Isolated SLAP lesions with no associated pathological findings are uncommon, and care must be taken when ascribing symptoms to a SLAP lesion when other lesions are present.Level of Evidence: Diagnostic study, Level IV-1 (case-control study). See p. 2 for complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74294018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sustained Spinal Cord Compression: Part I: Time-Dependent Effect on Long-Term Pathophysiology","authors":"G. Carlson, C. Gorden, H. S. Oliff, J. Pillai, J. LaManna","doi":"10.2106/00004623-200301000-00014","DOIUrl":"https://doi.org/10.2106/00004623-200301000-00014","url":null,"abstract":"Background: The objective of this study is to determine whether there is a relationship between the duration of sustained spinal cord compression and the extent of spinal cord injury and the capacity for functional recovery after decompression.Methods: Sixteen dogs underwent sustained spinal cord compression for thirty or 180 minutes. The cords were compressed with use of a loading device with a hydraulic piston. A pressure transducer was attached to the surface of the piston, which transmitted real-time spinal cord interface pressures to a data-acquisition system. Somatosensory evoked potentials were monitored during a sixty-minute recovery period as well as at twenty-eight days after the injury. Functional motor recovery was judged throughout a twenty-six-day period after the injury with use of a battery of motor tasks. The volume of the lesion and damage to the tissue were assessed with both magnetic resonance imaging and histological analysis.Results: Sustained spinal cord compression was associated with a gradual decline in interface pressure. Despite this, there was continuous decline in the amplitude of the somatosensory evoked potentials, which did not return until the cord was decompressed. Within one hour after the decompression, the dogs in the thirty-minute-compression group had recovery of somatosensory evoked potentials, but no animal had such recovery in the 180-minute group. Recovery of the somatosensory evoked potentials in the thirty-minute group was sustained over the twenty-eight days after the injury. Motor tests demonstrated rapid recovery of hindlimb motor function in the thirty-minute group, but there was considerable impairment in the 180-minute group. Within two weeks after the injury, balance, cadence, stair-climbing, and the ability to walk up an inclined plane were significantly better in the thirty-minute group than in the 180-minute group. The longer duration of compression produced lesions of significantly greater volume, which corresponded to the long-term functional outcome.Conclusions: The relatively rapid viscoelastic relaxation of the spinal cord during the early phase of sustained cord compression suggests that there are mechanisms of secondary injury that are linked to tissue displacement. Longer periods of displacement allow propagation of the secondary injury process, resulting in a lack of recovery of somatosensory evoked potentials, limited functional recovery, and more extensive tissue damage.Clinical Relevance: The findings underscore the importance of timely decompression to improve long-term functional recovery after spinal cord injury.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77267700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modern Unicompartmental Knee Arthroplasty with Cement: A Three to Ten-Year Follow-up Study","authors":"J. Argenson, Y. Chevrol-Benkeddache, J. Aubaniac","doi":"10.2106/00004623-200212000-00017","DOIUrl":"https://doi.org/10.2106/00004623-200212000-00017","url":null,"abstract":"Background: Unicompartmental arthroplasty is a treatment alternative when only one compartment of the knee is affected with arthritis, but the reported results of this procedure have been variable. The purpose of the present study was to evaluate the results of a modern unicompartmental knee arthroplasty performed with use of a cemented metal-backed prosthesis and surgical instrumentation comparable with that used for total knee replacement.Methods: The indications for the procedure were osteonecrosis or osteoarthritis associated with full-thickness loss of cartilage that was limited to one tibiofemoral compartment as evaluated on standing and stress radiographs. One hundred and sixty consecutive cemented metal-backed Miller-Galante prostheses in 147 patients were evaluated after a mean duration of follow-up of sixty-six months (range, thirty-six to 112 months). The mean age of the patients at the time of the index procedure was sixty-six years.Results: Three knees were revised because of progression of osteoarthritis in the patellofemoral joint (two knees) or the lateral tibiofemoral compartment (one knee). Two knees had revision of the polyethylene liner. The average Hospital for Special Surgery knee score improved from 59 points preoperatively to 96 points at the time of the review. According to Kaplan-Meier analysis, the ten-year survival rate (with twenty-nine knees at risk) was 94% ± 3% with revision for any reason or radiographic loosening as the end point.Conclusions: A modern unicompartmental knee arthroplasty is a valid alternative for patients with unicompartmental tibiofemoral noninflammatory disease. The patient selection must be strict with regard to the status of the patellofemoral joint. The preoperative planning includes stress radiographs to assess the correction of the deformity and the status of the uninvolved compartment. Continued long-term follow-up is necessary to evaluate long-term polyethylene wear.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80481565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patellar Tendinosis: A Follow-up Study of Surgical Treatment","authors":"A. Ferretti, F. Conteduca, Emanuela Camerucci, F. Morelli","doi":"10.2106/00004623-200212000-00009","DOIUrl":"https://doi.org/10.2106/00004623-200212000-00009","url":null,"abstract":"Background: Patellar tendinopathy (jumper's knee) is an overuse syndrome that frequently affects athletes. A retrospective study was done to analyze the results at a minimum of five years after the performance of a surgical technique in competitive athletes.Methods: From 1985 to 1995, thirty-two patients (thirty-eight knees) affected by patellar tendinopathy were treated surgically after failure of nonoperative treatment. All knees were operated on by the same surgeon using the same surgical technique: longitudinal splitting of the tendon, excision of any abnormal tissue that was identified, and resection and drilling of the inferior pole of the patella. The results in twenty-seven patients (thirty-three knees), including twenty-two athletes (twenty-seven knees) who were still involved in sports activities (or wished to still be involved) at a competitive level at the time of final follow-up, were reviewed at a mean of eight years postoperatively. The results were evaluated according to symptoms and the ability to return to full sports activities.Results: The result was excellent in twenty-three knees (70%), good in five, fair in one, and poor in four at the time of the long-term follow-up. Eighty-two percent of the patients who tried to pursue sports at their preinjury level were able to do so, and 63% of those knees were totally symptom-free.Conclusions: The outcome of the described surgical treatment appears to be satisfactory; however, the results are less predictable in volleyball players.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85874199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Synovial Entrapment: A Complication of Posterior Stabilized Total Knee Arthroplasty","authors":"D. Pollock, D. Ammeen, G. Engh","doi":"10.2106/00004623-200212000-00008","DOIUrl":"https://doi.org/10.2106/00004623-200212000-00008","url":null,"abstract":"Background: We observed a complication of posterior stabilized total knee arthroplasty involving hypertrophy of tissue proximal to the patella associated with pain during active knee extension from 90° of flexion. The purpose of this paper was to describe synovial entrapment and to determine if design features of the prosthesis predispose patients to the complication.Methods: Between April 1990 and June 1999, we performed 459 consecutive posterior stabilized primary total knee arthroplasties using three prosthetic designs with different femoral intercondylar geometries. We identified twenty-six patients (twenty-seven knees) in whom arthroscopic débridement of the knee or open arthrotomy with débridement of the knee had been subsequently performed because of a diagnosis of synovial entrapment. We reviewed the records of these patients to identify the knee components that had been used and the symptoms and conditions that necessitated additional treatment.Results: Symptoms (grating, crepitation, and pain with active knee extension from 90°) necessitating subsequent débridement occurred in 13.5% (nineteen) of 141 knees treated with the Anatomic Modular Knee-Congruency implant, 3.8% (eight) of 212 treated with the Anatomic Modular Knee-Posterior Stabilized implant, and none of the 106 treated with the Press Fit Condylar Sigma-Posterior Stabilized implant. All patients had difficulty rising from a chair and climbing stairs; however, none had symptoms when standing or walking. No patient had a patellar clunk. The symptoms occurred at a mean of seven months after the arthroplasty in the patients with an Anatomic Modular Knee-Congruency implant and at a mean of twenty months after the arthroplasty in those with an Anatomic Modular Knee-Posterior Stabilized implant. Débridement of the frond-like hypertrophic synovial tissue at the distal aspect of the quadriceps tendon alleviated symptoms in all patients. No nodules were identified during the arthroscopy.Conclusions: Synovial entrapment is characterized by hypertrophic synovial tissue at the superior pole of the patella. Use of a posterior stabilized femoral component with a proximally positioned or wide femoral box is more likely to result in this complication.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88265876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Osteolysis in Failed Total Knee Arthroplasty: A Comparison of Mobile-Bearing and Fixed-Bearing Knees","authors":"Chun‐Hsiung Huang, Hon-Ming Ma, J. Liau, F. Ho, Cheng-Kung Cheng","doi":"10.2106/00004623-200212000-00015","DOIUrl":"https://doi.org/10.2106/00004623-200212000-00015","url":null,"abstract":"Background: Osteolysis is an important complication associated with total knee arthroplasty. The purpose of this study was to compare the prevalence of osteolysis after failed total knee arthroplasty with a mobile-bearing prosthesis and after failed arthroplasty with a fixed-bearing prosthesis.Methods: Eighty revision total knee arthroplasties performed between 1995 and 1998 were included in this study. All had radiographic evidence of advanced polyethylene wear. The mobile-bearing group consisted of thirty-four knees with a Low Contact Stress implant, and the fixed-bearing group included forty-six knees. The average time (and standard deviation) from the primary operation to the revision was 102.8 ± 26.5 months in the mobile-bearing group and 96.0 ± 30.1 months in the fixed-bearing group. The prerevision radiographs and operative findings were reviewed.Results: The prevalence of osteolysis was significantly higher in the mobile-bearing group (47%; sixteen of thirty-four knees) than in the fixed-bearing group (13%; six of forty-six knees) (p = 0.003). The distal part of the femur was involved in thirteen knees in the mobile-bearing group and in four knees in the fixed-bearing group. Seventeen knees had osteolysis in the posterior aspect of the femoral condyle, which was the most common site of osteolysis; however, twelve of them had no evidence of osteolysis on prerevision radiographs.Conclusions: The prevalence of osteolysis was higher in the knees with a mobile-bearing prosthesis than in those with a fixed-bearing prosthesis. The osteolysis was predominantly on the femoral side, adjacent to the posterior aspect of the condyle. Radiographic evaluation of osteolysis in the distal part of the femur may not be reliable and usually leads to an underestimation of the degree of osteolysis.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78212679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}