Clinical and radiographic evaluation of a monoblock tibial component.

Modular tibial components are the clinical standard in total knee arthroplasty despite the lack of evidence of improved function and longevity when compared with monoblock implants. This study describes the minimum 5-year outcomes for 125 total knee arthroplasties performed with monoblock tibial components in 101 patients. No patients were lost to follow-up.

Bone remodeling around porous metal cementless acetabular components.

Bone remodeling around cementless acetabular components after total hip arthroplasty has not been well characterized. A randomized, prospective study of total hip arthroplasty was performed comparing 2 cementless acetabular implants: a solid titanium and a more elastic porous tantalum design. Seventeen hips (9 porous tantalum, 8 titanium) underwent quantitative computed tomography at mean of 7.

Mechanical stability of novel highly porous metal acetabular components in revision total hip arthroplasty.

Highly porous metal acetabular components have emerged for revision hip arthroplasty. However, superior mechanical stability over traditional cementless components has not been demonstrated. Three different cementless acetabular components, including 2 highly porous tantalum designs, were inserted into hemipelvis specimens with a superolateral defect.

Use of porous tantalum metaphyseal cones for severe tibial bone loss during revision total knee replacement. Surgical technique.

Background: The best treatment method for large tibial bone defects during revision knee replacement has not been established. The purpose of this study was to determine the initial results obtained with a unique reconstructive implant, the porous tantalum metaphyseal cone, designed as an alternative treatment for severe tibial bone loss following total knee arthroplasty.

Methods: Porous tantalum metaphyseal cones were implanted during fifteen revision total knee replacements in eight women and seven men who had an average age of 68.

Limitations of structural allograft in revision total knee arthroplasty.

Unlabelled: Management of large bone defects in total knee arthroplasty (TKA) usually has involved modular prostheses with metal augments, structural allografts, and megaprostheses. We retrospectively reviewed the outcome of treatment of major bone defects for 74 patients (79 knees) who had revision TKAs with structural allografts; nine patients were lost to followup before 5 years, leaving 65 patients (70 knees, or 88%) followed for a minimum of 5 years or until revision or death. Medical records, radiographs, patient surveys, and correspondence were used for all data.

What patient and surgical factors contribute to implant wear and osteolysis in total joint arthroplasty?

Total joint arthroplasty has been a successful operation for decades. Our current patients are younger and more active than those in the past. They place higher demands on themselves and have expectations commensurate with their lifestyles.

The impact of gender, age, and preoperative pain severity on pain after TKA.

Unlabelled: Do gender and age affect knee arthroplasty outcomes? In a cohort of patients who underwent primary or revision TKA between 1996 and 2004 and responded to a followup questionnaire 2 and 5 years after arthroplasty, we investigated the impact of gender and age on the prevalence of moderate or severe post-TKA knee pain (primary TKA: 2 years, 5290; 5 years, 2602; revision TKA: 2 years, 1109; 5 years, 505). Moderate-severe pain was higher in women than men after primary TKA at 2 and 5 years (9% versus 6.6% and 7.

Modes of failure of Osteonics constrained tripolar implants: a retrospective analysis of forty-three failed implants.

Background: The Osteonics constrained tripolar implant has been one of the most commonly used options to manage recurrent instability after total hip arthroplasty. Mechanical failures were expected and have been reported. The purpose of this retrospective review was to identify the observed modes of failure of this device.

Detection of intact influenza viruses using biotinylated biantennary S-sialosides.

We report the modular synthesis of robust, biotinylated biantennary sialylglycoconjugates and their ability to differentiate between two type A influenza strains. This is the first demonstration of glycoconjugate-based discriminatory capture and detection of two strains of intact influenza virus, in the presence of the innate enzymatic activity of viral neuraminidases. We also demonstrate a "carboassay" using glycoconjugates as capture and reporter elements, which therefore, does not require antibodies.

Use of porous tantalum metaphyseal cones for severe tibial bone loss during revision total knee replacement.

Background: The best treatment method for large tibial bone defects during revision knee replacement has not been established. The purpose of this study was to determine the initial results obtained with a unique reconstructive implant, the porous tantalum metaphyseal cone, designed as an alternative treatment for severe tibial bone loss following total knee arthroplasty.

Methods: Porous tantalum metaphyseal cones were implanted during fifteen revision total knee replacements in eight women and seven men who had an average age of 68.

Successful canine patellar tendon reattachment to porous tantalum.

The ability to achieve reattachment of soft tissues, such as tendon, directly onto a prosthetic surface would be of great benefit in case of periarticular bone loss or resection. Bone and potential soft tissue ingrowth using porous tantalum has been observed in prior animal studies. We hypothesized porous tantalum washers used to reattach canine patellar tendon to bone would provide sufficient strength to withstand physiologic loading.

Direct tendon attachment and healing to porous tantalum: an experimental animal study.

Background: The ability to directly attach soft-tissue to metal would have broad clinical application. Previous attempts to obtain normal tendon-to-bone attachment strength have been unsuccessful. In the present study, we hypothesized that when the initial interface mechanical environment is carefully controlled, a highly porous form of tantalum metal would allow the ingrowth of tendon tissue with clinically relevant tendon-to-implant fixation strength approaching that of an intact tendon-to-bone insertion.

Preliminary results of tantalum acetabular components for THA after pelvic radiation.

Total hip arthroplasty after previous therapeutic pelvic radiation has been associated with high acetabular component loosening rates. We report 12 total hip arthroplasties performed in 11 patients who had therapeutic pelvic radiation to treat an underlying malignancy. The total hip arthroplasties were performed with porous tantalum trabecular metal acetabular components.

Intraoperative fractures of the acetabulum during primary total hip arthroplasty.

Background: The intraoperative occurrence of an acetabular fracture is a rare complication of primary total hip arthroplasty. Previous reports have lacked a sufficiently large number of subjects to allow for an analysis of the causes and appropriate treatment of this problem.

Methods: Between 1990 and 2000, 7121 primary total hip arthroplasties were performed at our institution.

Local antibiotic delivery with OsteoSet, DBX, and Collagraft.

Biodegradable local antibiotic delivery systems have gained interest for prophylaxis and treatment of musculoskeletal infections. We studied the biodegradable materials Osteo- Set, DBX and Collagraft for local delivery of vancomycin and gentamicin in vitro. We determined the antimicrobial activity of vancomycin and gentamicin after mixing with each biodegradable material and determined the release of each antimicrobial from each material in an intermittent flow chamber.

Transsciatic foramen pedicle VRAM coverage of gluteal defects.

Tumors of the gluteal region are rare. Defects from resection often can be closed primarily. Some patients require local flaps such as a gluteus maximus V-Y advancement flap.

"Broken heart syndrome" after separation (from OxyContin).

We describe a 61-year-old woman with "broken heart syndrome" (Takotsubo-like cardiomyopathy) after abrupt postsurgical withdrawal of OxyContin. Her medical history was remarkable for long-term opiold dependence associated with the treatment of multi-Joint degenerative osteoarthritis. The patient presented to the emergency department 1 day after discharge from the hospital following total knee arthroplasty revision with acute-onset dyspnea and mild chest pain.

Total hip arthroplasty in patients with renal failure: a comparison between transplant and dialysis patients.

This study analyzed the outcome of total hip arthroplasty (THA) from a single institution of patients with renal failure, including renal dialysis patients (9 patients, 9 hips) and renal transplant patients (28 patients, 36 hips). There were 12 revisions and a 61% complication rate in the transplant group. In the dialysis group, 1 patient was revised, and there was a 33% complication rate.

Lack of detection of human retrovirus-5 proviral DNA in synovial tissue and blood specimens from individuals with rheumatoid arthritis or osteoarthritis.

Objective: Prior studies have suggested an association of human retrovirus 5 with rheumatoid arthritis. The purpose of this study was to determine if human retrovirus-5 proviral DNA is present in synovial tissue and blood specimens from patients with rheumatoid arthritis or osteoarthritis, or those without joint disease.

Methods: Synovial tissue and whole blood from 75 patients with rheumatoid arthritis, 75 patients with osteoarthritis, and 50 patients without a primary arthritis diagnosis were assayed by real-time quantitative polymerase chain reaction (PCR) using primers that amplify a 186-bp fragment of human retrovirus-5 proviral DNA.

Perioperative morbidity and 30-day mortality after intertrochanteric hip fractures treated by internal fixation or arthroplasty.

The conventional treatment for intertrochanteric hip fracture is open reduction and internal fixation. However, hip arthroplasty is occasionally performed. The objective of this study was to determine the 30-day mortality for patients with intertrochanteric hip fracture treated with open reduction, internal fixation, or hip arthroplasty.

Canine carpal joint fusion: a model for four-corner arthrodesis using a porous tantalum implant.

Purpose: Interest has focused on porous materials that promote bony ingrowth. In this study a porous tantalum implant was used as an adjunct to intercarpal stabilization in a canine model of wrist arthrodesis.

Methods: A defect was created at the junction of the radiocarpal, ulnocarpal, and fourth carpal bones, analogous to a four-corner fusion site in humans.

Two-incision THA had modest outcomes and some substantial complications.

Unlabelled: Proponents of two-incision total hip arthroplasty suggest the technique is minimally invasive and promotes rapid rehabilitation with a low prevalence of complications. We applied the two-incision total hip arthroplasty technique to a consecutive group of unselected patients with primary degenerative arthritis to determine the technical difficulty of the operation as measured by the operative time compared with a standard posterior approach, the safety of the operation as measured by the prevalence of complications compared with a standard posterior approach, and the early functional outcome measured by the time to return to activities of daily living as compared with a previous study of the two-incision technique in selected younger patients. The 80 patients included 45 women and 35 men with a mean age of 70.