The effectiveness of warfarin dosing from a nomogram compared with house staff dosing.

The purpose of this study is to address the safety and efficacy of a warfarin dosing nomogram. Patients undergoing hip or knee arthroplasty were randomized to warfarin dosed by nomogram (n = 106) or by house staff (n = 110) during their hospital stay. The average daily dose of warfarin was 4.

Varus rotational osteotomies for adults with hip dysplasia: a 20-year followup.

Untreated hip dysplasia predisposes young adults to early arthritis. Varus rotational osteotomies are considered one option to delay or eliminate total hip arthroplasty. We update a report from 1991 by retrospectively reviewing 40 of 48 patients (83.

Patellar crepitation in the P.F.C. sigma total knee system.

Painless and painful patellar crepitation and patellar clunk syndrome represent a spectrum of peripatellar scar formation particular to posterior-stabilized knee components, although it may occur with cruciate-retaining designs as well. The formation of peripatellar inflammatory scar tissue is related to implant design and surgical technique, with microscopic and gross findings indicating varying degrees of inflammatory fibrous hyperplasia. These well recognized clinical entities have an incidence ranging between 1% and 5% in different series.

The P.F.C. sigma RP-F TKA designed for improved performance: a matched-pair study.

The press fit condylar P.F.C.

The P.F.C. sigma RP-F total knee arthroplasty: designed for improved performance.

The new P.F.C.

Diagnosis and management of traumatic and atraumatic hip instability in the athletic patient.

Although relatively uncommon compared with the shoulder, hip instability can be a source of significant disability and is a commonly unrecognized injury. Hip instability can be traumatic or atraumatic in origin. Our understanding and treatment plan for hip instability due to traumatic events is well established.

Experience with an all-polyethylene total knee arthroplasty in younger, active patients with follow-up from 2 to 11 years.

There are few modern reports that document the results of all-polyethylene (all-poly) tibial components in younger, active patients. The potential benefits of this design are the elimination of backside wear and lower implant cost than modular, metal-backed components. Nonetheless, since the mid 1980s, modular, metal-backed tibial trays have dominated the total knee arthroplasty market based on finite-element analysis studies that demonstrated superior force distribution compared with conventional all-poly components.

Total knee arthroplasty for severe valgus deformity.

Background: In 1985, the senior author (C.S.R.

Total knee arthroplasty for severe valgus deformity. Five to fourteen-year follow-up.

Background: In 1985, the senior author (C.S.R.

A prospective, randomized, double-blind study of smooth versus rough stems using cement fixation: minimum 5-year follow-up.

This prospective randomized double-blind study aims to evaluate the effect of surface finish of the cemented femoral stem in primary total hip arthroplasty. Between January 1996 and May 1997, a single surgeon prospectively implanted 244 primary THAs (237 patients) using cemented femoral stems with modified third-generation cement technique in selected patients. Patients were randomized to receive the Ranawat-Burstein prosthesis (Biomet, Warsaw, IN) with 1 of 2 finishes (smooth-Ra 17 or rough-Ra 170).

Mastering the art of cemented femoral stem fixation.

Cemented femoral stem fixation is reproducible and provides excellent early recovery of hip function in patients 60 to 80 years old. The durability of fixation has been evaluated up to 20 years with 90% survivorship. Achieving a uniform cement mantle and minimizing polyethylene wear has been shown to reduce the incidence of fixation failure.

Comparison of the PFC Sigma fixed-bearing and rotating-platform total knee arthroplasty in the same patient: short-term results.

This study compares the fixed-bearing PFC Sigma Total Knee Arthroplasty to the recently introduced rotating-platform version of the same design in 26 patients. At an average follow-up time of 46 months for the fixed-bearing side and 16 months for the rotating-platform side, no significant differences were found in terms of knee preference, knee pain, range of motion, overall satisfaction, or Knee Society scores (KSSs). No revisions, subluxations, dislocations, or infections were seen.

Total knee arthroplasty rehabilitation protocol: what makes the difference?

The goals of any rehabilitation protocol should be to control pain, improve ambulation, maximize range of motion,develop muscle strength, and provide emotional support. Over 85% of total knee arthroplasty (TKA) patients will recover knee function regardless of which rehabilitation protocol is adopted. However, the remaining 15% of patients will have difficulty obtaining proper knee function secondary to significant pain, limited preoperative motion, or the development of arthrofibrosis.

Effect of stem stiffness and bone stiffness on bone remodeling in cemented total hip replacement.

The hypothesis in this study is that the stem stiffness-to-bone stiffness ratio influences the incidence and type of bone remodeling and fixation with cemented total hip arthroplasty. Ninety-one patients with 99 hips had cemented stems using 3 different anatomic porous replacement designs. The APR I and APR II titanium stems with proximal porous coating on the proximal one fourth of the stem were cemented into 49 and 35 patients.

Bilateral total hip arthroplasty comparing hydroxyapatite coating to porous-coated fixation.

Fifteen patients had bilateral hip replacement with a porous-coated hip replacement in one hip and in the contralateral hip the same design, which had adjunctive hydroxyapatite coating on the porous coating. These patients were followed for an average of 6.5 years (range, 5-7.

Hydroxyapatite-coated femoral stems. A matched-pair analysis of coated and uncoated implants.

Fifty-two pairs of patients who had had a total hip arthroplasty with a porous-coated femoral implant were studied in a retrospective, matched-pair analysis. Half of the patients had received a femoral component coated with hydroxyapatite and the other half (the controls), an identical component but without hydroxyapatite. The patients were matched for age, sex, weight, diagnosis, Charnley class, operative approach, and duration of follow-up.