-
[show abstract]
[hide abstract]
ABSTRACT: A cross-sectional study of 100 surgeons and 370 patients awaiting primary total hip or knee replacement was carried out. Oxford hip or knee score questionnaires were sent to the surgeons and patients. They were asked to predict the level of symptoms expected 6 months following surgery. The Oxford scores derive a value of 12-60, with a greater score indicating worsening symptoms. The mean pre-operative score was 45.12 for the hip patients and 42.96 for the knee patients, and the patients expected this to drop to 23.70 and 25.66, respectively, 6 months' postoperatively. This was a significant difference for both groups. The surgeons expected the patients to have a mean postoperative score of 20.91 for the hip group and 22.19 for the knee group. The surgeons' scores were significantly lower than those from the patients. There was a significant difference between the patients' and surgeons' expectations of the results of total knee and hip replacement surgery. The surgeons expected better results than the patients. We believe that this is the first study that directly compares surgeon and patient expectations of lower limb arthroplasty.
Annals of The Royal College of Surgeons of England 06/2003; 85(3):204-6. · 1.23 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The preoperative concerns of patients undergoing total knee or hip arthroplasty were evaluated in a cross-sectional study of 370 patients. Patients completed a questionnaire on 29 concerns, each rated on a scale of 1 (not concerned) to 4 (very concerned). Short Form 12 and Oxford hip or knee scores were also calculated. The results showed that the greatest concern for patients was cancellation of the surgery. This was followed by failure of the surgery to reduce pain, loss of a limb, and joint infection. Concerns regarding scar problems, nursing care, and preoperative tests were the lowest. Women showed statistically significant greater concerns in 9 areas. Younger patients (age, <65) showed increased concerns in 8 areas. Patients who had previously undergone joint arthroplasty were less concerned than those who had not undergone previous lower limb joint arthroplasty for 6 responses. They showed increased concern in 2 areas, nursing care and hospital food. Those undergoing total hip arthroplasty were more concerned about dislocation, dressing, and returning to work (all, P<.05). This study provides useful information for the preoperative counseling of patients and the production of preoperative literature.
The Journal of Arthroplasty 06/2003; 18(4):442-5. · 2.38 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This study investigated the perceived risks and complications associated with total hip arthroplasty for Paget's disease. A total of 98 Charnley low-friction arthroplasties were performed on 76 patients, 27 men (37 hips) and 49 women (61 hips), whose average age was 67.4 years (range, 51-79 years). Intraoperative blood loss averaged 388 mL (range, 110-1,730 mL), and minor heterotopic ossification occurred in 24 hips (25%), with significant changes in 4 hips (4%). After average follow-up of 10.4 years (range, 5.5-20 years), 10 acetabular (10%) and 8 femoral (8%) implants had loosened aseptically, but there was no evidence of progressive protrusio acetabuli or femoral deformity after operation. Survivorship to revision was 98% at 10 years (95% confidence interval [CI], 95%-100%) and 91% at 15 years (95% CI, 80%-100%) for the acetabular component and 93% (95% CI, 87%-99%) and 89% (95% CI, 80%-99%) for the femur. The only increased risk identified was nonunion of the trochanteric osteotomy (13%).
The Journal of Arthroplasty 03/2000; 15(2):210-9. · 2.38 Impact Factor
-
D H Sochart
[show abstract]
[hide abstract]
ABSTRACT: Polyethylene wear and the subsequent development of periprosthetic osteolysis are the major factors limiting the longevity of total hip arthroplasties. A minority eventually loosen, but no clinically applicable system exists for accurate early prediction of failure. The relationship between acetabular wear and the development of loosening, osteolysis, and revision was investigated in 235 Charnley low friction arthroplasties. The average age of the patient at surgery was 31.7 years (range, 17-39 years), and the duration of followup averaged 234 months (19.5 years; range, 74-364 months). Total wear averaged 2.1 mm (range, 0-7.2 mm), and the average wear rate was 0.11 mm per year (range, 0-0.55 mm/year), with the wear rate of revised components being twice that of surviving ones (0.19 mm/year versus 0.09 mm/year). The prevalence of osteolysis (33 hips, 14%) and of acetabular and femoral component loosening and revision rose significantly with increasing wear. Osteolysis also was associated significantly with femoral component loosening and revision, but the presence of calcar changes was not (90 hips, 38%). Twenty-five year survivorship exceeded 90% for arthroplasties with a wear rate less than 0.1 mm per year, but 20-year survivorship of acetabular components with a rate greater than 0.2 mm per year was below 30%, and none survived 25 years. For every additional millimeter of wear, the risk of acetabular revision in any one year increased by 45% and for the femur increased by 32%.
Clinical Orthopaedics and Related Research 07/1999; · 2.53 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We have studied the relationship between movements of the foot and ankle and venous blood flow from the lower limb using colourflow Duplex ultrasound to determine the optimum type of exercise for promoting venous return. Studies of both active and passive movements were carried out on 40 limbs in 20 subjects (18 men; 2 women), with a median age of 27 years (20 to 54). We assessed ankle dorsiflexion and plantar flexion, subtalar inversion and eversion, and a combination of all movements. There was no difference in venous flow when comparing opposite limbs in a single subject (p > 0.5), but active exercises produced higher peak and mean velocities of blood flow than passive ones. The active combined movement produced the highest velocities with an increase of 38% in mean and of 58% in peak flow velocities, which were significantly greater than the peak and mean flow rates produced by passive movements. The active combined exercise would therefore be the most effective in eliminating stasis and could contribute to the prevention of deep-vein thrombosis.
Journal of Bone and Joint Surgery - British Volume 07/1999; 81(4):700-4. · 2.83 Impact Factor
-
D H Sochart
Orthopedics 12/1998; 21(11):1228-31. · 2.66 Impact Factor
-
The Journal of Bone and Joint Surgery 10/1998; 80(9):1397-8. · 3.27 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Between 1981 and 1986 two groups of patients received either Charnley low-friction arthroplasties or the Wrightington Frusto-Conical hip replacement with otherwise identical management before and after operation. There were 260 consecutive replacements in 215 patients in the first group and 260 consecutive procedures in 211 patients in the second. Both components of each design were cemented and featured a 22.25 mm femoral head, but the geometry of the stems differed. Of the patients lost to follow-up, 16 (18 hips) were in the Wrightington series and 24 (36 hips) in the Charnley series, and of those who have died 20 (23 hips) were Wrightington and 14 (16 hips) were Charnley. All surviving patients have been followed up clinically and radiologically or until revision was necessary. The mean length of follow-up for original surviving components in both series was 140 months (120 to 180). Pain, function and movement were measured by the grading system of Merle D'Aubigné and Postel and showed a marked improvement in both groups. There was little or no pain in 98% of patients in the Wrightington series and 96% in the Charnley series, while 93% and 85%, respectively, were entirely painfree. Trochanteric osteotomy was used in 292 cases overall, with a complication rate of 13% due to wire breakage, trochanteric bursitis or trochanteric detachment, requiring a further operation in 5.8% (17 hips). Heterotopic ossification was seen in 40% of cases in which trochanteric osteotomy had been performed (117 hips) but only 3% (10 hips) had clinically significant changes. After the direct lateral approach heterotopic ossification was seen in 24% (42 hips) with only 2% in class 3 or 4 (4 hips). Femoral osteolysis was more common in the Charnley series, occurring in 7.6% of cases (17 hips) as opposed to 2.1% (5 hips) in the Wrightington series. Ten acetabular and seven femoral components have been revised in the Wrightington series and 16 acetabular and 11 femoral implants in the Charnley series. Survivorship based on revision for aseptic loosening using the Kaplan-Meier technique showed survival of the femoral implant at 5, 10 and 15 years of 100%, 99% and 98%, respectively in the Wrightington and 100%, 99% and 87% in the Charnley series. The survival of the acetabular component at 10, 12 and 15 years respectively, was 100%, 99% and 95% for the Wrightington, and 99%, 98% and 84% for the Charnley. The survival of both the acetabular and femoral components of the Wrightington system at a mean of 11.7 years was better than that of the Charnley system, with a lower incidence of radiological loosening of unrevised components.
Journal of Bone and Joint Surgery - British Volume 08/1998; 80(4):577-84. · 2.83 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The results of cemented Charnley low-friction arthroplasty in patients aged less than 30 years are presented. Eighty-three arthroplasties were performed on 55 patients with an average age of 24.9 years (range, 17-29 years) and an average follow-up period of 240 months (20 years; range, 62-360 months). There were 2 nonfatal pulmonary emboli, 2 cases of deep sepsis, and 3 fractured femoral implants. Twenty-eight acetabular components migrated (34%), 25 have been revised (30%), and the average annual acetabular wear rate was 0.12 mm. Sixteen femoral implants subsided (19%), and fracture of the tip of the cement mantle occurred in 8 hips (10%). Nineteen femoral components (23%) were revised; femoral osteolysis was seen in 15 hips (18%) and changes in the calcar in 33 (38%). Acetabular component survivorship was 92% (95% confidence interval, 85-98%) at 10 years, 70% (60-81%) at 20 years, and 68% (57-79%) at 25 years, with the figures for the femoral implant being 93% (87-98%), 76% (66-86%), and 73% (62-85%), respectively.
The Journal of Arthroplasty 02/1998; 13(2):123-31. · 2.38 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Supracondylar fracture of the femur above a total knee arthroplasty has been reported to occur in 0.3-2.5% of all cases. The case of a patient who sustained such a fracture subsequent to a fall and whose fracture was managed without surgery with a good result is reported. There was no evidence of coexisting loosening, osteolysis, or significant wear, and satisfactory bony reduction was achieved, maintaining correct alignment of the prosthetic components. Healing occurred in 3 months, and the patient remains under follow-up evaluation with a painless knee and a range of movement similar to prefracture levels with no evidence of implant loosening. Despite the current enthusiasm for internal fixation of these fractures, a review of the current literature revealed that neither conservative nor operative management has a significant proven advantage, and the treatment of these difficult and uncommon fractures remains challenging. Nonoperative treatment of fractures above well-fixed components can, however, be as successful as surgical intervention, and remains a viable first-line approach. Conservative management also lacks the potential risks of operation, while maintaining the option of later surgical intervention if required.
The Journal of Arthroplasty 11/1997; 12(7):830-4. · 2.38 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We present the long-term results of 226 Charnley low-friction arthroplasties that were performed with use of cement in 161 patients between 1966 and 1978. Forty-four patients (sixty hips) had congenital dislocation of the hip, fifty-four patients (sixty-six hips) had degenerative osteoarthrosis, and sixty-three patients (100 hips) had rheumatoid arthritis. There were 114 female patients and forty-seven male patients. The average age of the patients at the time of the operation was 31.7 years (range, seventeen to thirty-nine years). Sixty-five patients (40 per cent) had a bilateral hip replacement. Thirty-eight patients (24 per cent; fifty-five hips), twenty-seven of whom had juvenile-onset chronic rheumatoid arthritis, died during the follow-up period. The average duration of follow-up for the entire series until the time of death, revision of both components, or the latest evaluation was 236 months (19.7 years; range, twenty-four to 361 months). Survivorship analysis was performed with the Kaplan-Meier method. At twenty-five years, the survival of the femoral component (with 95 per cent confidence intervals) was 89 per cent (80 to 98 per cent) in the patients who had congenital dislocation of the hip, 85 per cent (77 to 93 per cent) in the patients who had rheumatoid arthritis, and 74 per cent (61 to 87 per cent) in the patients who had degenerative osteoarthrosis. The rate of survival of the acetabular component was lower: at twenty-five years, it was 58 per cent (42 to 74 per cent) in the patients who had congenital dislocation, 79 per cent (70 to 88 per cent) in the patients who had rheumatoid arthritis, and 59 per cent (41 to 77 per cent) in the patients who had degenerative osteoarthrosis. The forty-four patients (sixty hips) who had congenital dislocation had the highest rates of aseptic loosening (twenty-two hips; 37 per cent), migration (seventeen hips; 28 per cent), and revision (twenty-two hips; 37 per cent) of the acetabular component. The fifty-four patients (sixty-six hips) who had degenerative osteoarthrosis had the highest rates of aseptic loosening (seventeen hips; 26 per cent) and revision (eighteen hips; 27 per cent) of the femoral component as well as the highest rate of femoral endosteal lysis (thirteen hips; 20 per cent). The sixty-three patients (100 hips) who had rheumatoid arthritis had the lowest prevalences of loosening and revision of the acetabular component but the highest rates of trochanteric non-union (fifteen hips; 15 per cent) and mortality (twenty-seven patients; 43 per cent). The average rate of wear of the acetabular component for the entire series was 0.11 millimeter per year; the average rate for the revised components (0.19 millimeter per year) was higher than that for the surviving components (0.09 millimeter per year). This was a consistent finding in each of the three diagnostic groups, and an increased annual rate of wear was found to be significantly associated with increased rates of migration and revision of the acetabular component (p < 0.01 for both). The femoral component proved to be durable: the twenty-five-year rate of survival for the entire series was 81 per cent (95 per cent confidence interval, 76 to 87 per cent). The major factors that limited the longevity of the cemented total hip implants in the present study were wear, loosening, and revision of the acetabular component, for which the twenty-five-year probability of survival was 68 per cent (95 per cent confidence interval, 61 to 75 per cent).
The Journal of Bone and Joint Surgery 11/1997; 79(11):1599-617. · 3.27 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We determined the long-term results of total hip replacement in a series of young patients who had ankylosing spondylitis. Between 1966 and 1978, forty-three Charnley low-friction arthroplasties were performed in twenty-four patients who had an average age of 28.8 years (range, nineteen to thirty-nine years) at the time of the operation. There were seventeen men and seven women. The average duration of follow-up for the series was 22.7 years (range, one month [a perioperative death] to 30.3 years). Four patients (seven hips) had died an average of 12.6 years (range, one month to 18.7 years) after the operation. The twenty surviving patients had clinical and radiographic follow-up until the time of writing or until both of the original components had been revised. All patients had substantial relief of pain and improvement of function and the range of motion of the joint. Twenty-one patients (88 per cent; thirty-nine hips) were completely free of pain (6 points, according to the scale of Merle d'Aubigne and Postel), and the remainder had only slight discomfort (5 points). Ten acetabular components and one femoral component were revised because of aseptic loosening, and one patient had a revision of both components because of late deep infection. Three additional femoral components were revised during a revision operation for a loose acetabular component. Although the femoral components were not loose, they had been in place for more than ten years and it was thought likely that the bearing surface was damaged. The average time to revision was 13.3 years (range, 4.0 to 20.3 years). At an average of 22.7 years, thirty-eight (88 per cent) of the original femoral components and thirty-two (74 per cent) of the original acetabular components remained in situ. The average annual rate of acetabular wear was 0.12 millimeter for the entire series. Only six hips (14 per cent) had minor heterotopic ossification, and none of the hips had clinically important ossification (class III or IV according to the system of Brooker et al.). To our knowledge, the present report describes the largest series of total hip arthroplasties, with the longest duration of follow-up, in young patients who had ankylosing spondylitis. Survivorship analysis with use of the Kaplan-Meier method revealed that the probability of survival of the femoral component (with 95 per cent confidence intervals) was 91 per cent (83 to 99 per cent) at twenty years and 83 per cent (72 to 94 per cent) at thirty years. The probability of survival of the acetabular components was 73 per cent (61 to 84 per cent) at twenty years and 70 per cent (57 to 83 per cent) at thirty years. The probability that both components would survive was 91 per cent (82 to 100 per cent) at ten years, 73 per cent (61 to 84 per cent) at twenty years, and 70 per cent (57 to 83 per cent) at thirty years. The Charnley low-friction arthroplasty provided consistently good long-term results, with a low rate of complications and revisions, in this group of young patients.
The Journal of Bone and Joint Surgery 09/1997; 79(8):1181-9. · 3.27 Impact Factor
-
Annals of The Royal College of Surgeons of England 12/1996; 78(6):557. · 1.23 Impact Factor
-
BMJ 08/1996; 313(7049):66-7. · 14.09 Impact Factor
