Average Postoperative Range Of Motion Research Articles

Periacetabular osteotomy for the treatment of dysplastic hip with Perthes-like deformities

We retrospectively evaluated 17 hips in 16 patients who underwent a periacetabular osteotomy for the treatment of dysplastic hip with Perthes-like deformities. These residual deformities were graded using the Stulberg classification system. There were three class II hips, 11 class III hips and three class IV hips preoperatively. The average age of the patients at surgery was 36.9 years and the average follow-up was 6.6 years. The average Harris hip score significantly improved from the preoperative value of 68.2 points to 91.1 points postoperatively. The average postoperative range of motion in all directions did not change significantly from the preoperative value. The average postoperative Harris hip score of class IV hips was smaller than that of the class II or class III hips. The standard radiographic evaluations also showed significant improvements postoperatively. Periacetabular osteotomy without combined femoral osteotomies, as a treatment for patients with Perthes-like deformities, produced good clinical and radiographic results.

Resurfacing Arthroplasty Versus Silicone Arthroplasty for Proximal Interphalangeal Joint Osteoarthritis

To compare the outcomes of silicone proximal interphalangeal joint (PIPJ) arthroplasties to pyrolytic carbon implants in patients with osteoarthritis. This study is a retrospective review of 41 arthroplasties in 22 patients with severe PIPJ osteoarthritis performed by a single surgeon. There were 13 patients and 22 joints in the silicone group with an average follow-up of 45 months. There were 9 patients and 19 joints in the pyrolytic carbon group with an average follow-up of 19 months. Clinical assessment included range of motion, grip strength, and deformity. Radiographs were evaluated for alignment, subsidence, and implant fracture. Patients filled out a subjective questionnaire with respect to pain, appearance of the finger, and satisfaction. Complications were recorded. In the silicone group, the average preoperative PIPJ range of motion (ROM) was 11 degrees /64 degrees (extension/flexion) and the average postoperative ROM was 13 degrees /62 degrees . In the pyrolytic carbon group, the average preoperative PIPJ ROM was 11 degrees /63 degrees and the average postoperative ROM was 13 degrees /66 degrees . Eleven of 20 joints in the silicone group and 4 of 19 joints in the pyrolytic carbon group had a coronal plane deformity as defined by angulation of the PIPJ > or =10 degrees . The average coronal plane deformity was 12 degrees in the silicone group and 2 degrees in the pyrolytic carbon group. The difference was statistically significant. In the silicone group, 3 of 22 joints required additional surgery. Two implants in one patient were removed and the PIPJ fused, and one implant was permanently removed for sepsis. In the pyrolytic carbon group, 8 of 19 joints squeaked, and there were 2 early postoperative dislocations and 2 implants with radiographic loosening. To date, there has been no revision surgery. Both groups had good pain relief. Patients were generally satisfied with the appearance of their joints in the pyrolytic carbon arm; however, satisfaction with appearance was variable in the silicone group. Nine of 13 patients in the silicone group and 6 of 7 patients in the pyrolytic carbon group would have the procedure again. Both implants provide excellent pain relief and comparable postoperative ROM. Complications were implant specific. The results of this series show promise for the pyrolytic carbon PIPJ resurfacing arthroplasty but did not clearly demonstrate superiority compared with the silicone implant.

The anterior–posterior laxity after total knee arthroplasty inserted with a ligament tensor

Goal of this study is to determine the anterior-posterior laxity in 30 degrees of knee flexion for a posterior cruciate retaining total knee arthroplasty with a relative dished insert and implanted with a ligament tensor. Furthermore, the correlation between these AP laxities and the postoperative range of motion (ROM) and postoperative Knee Society Score (KSS) is analysed. Fifty-one balanSys total knee arthroplasties were performed in 49 patients between 1998 and 2000. These arthroplasties are analysed with respect to AP laxity (Rolimeter), ROM and KSS with a mean follow-up of 4.6 years. The mean anterior laxity is 2.8 mm with no posterior laxities at all. The average postoperative ROM is 110 degrees with an average KSS of 142. No correlations between AP-laxity and postoperative ROM or between AP-laxity and postoperative KSS are found. A posterior cruciate retaining TKA with a relative dished insert and implanted with a tensor is very stable in the anterior-posterior direction in 30 degrees of knee flexion. This limited laxity does not seem to disadvantage the mean postoperative ROM and KSS, when compared to other TKA studies.

Pyrolytic Carbon Proximal Interphalangeal Joint Resurfacing Arthroplasty

To evaluate the clinical results of a pyrolytic carbon resurfacing proximal interphalangeal joint (PIPJ) arthroplasty in patients with osteoarthritis. A retrospective review of 18 PIPJ arthroplasties in 8 women with severe osteoarthritis performed by a single surgeon was completed with an average follow-up period of 13 months. Clinical assessment included range of motion (ROM), stability, and deformity. Radiographs were reviewed for evidence of loosening, subsidence, fracture, and osseointegration. Six patients, representing 16 joints, answered a questionnaire regarding pain relief, appearance, and overall satisfaction with the arthroplasty. Complications also were recorded. The average preoperative ROM was 10 degrees to 63 degrees, and the average postoperative ROM was 18 degrees to 71 degrees. Although the average arc of motion was unchanged, 9 joints had an increase in ROM and 9 joints had a decrease in ROM. All joints were stable laterally. Radiographic review indicated 2 joints with loosening at 4 months after surgery. Complications included 8 squeaky joints, 5 joint contractures, and 2 dislocations. Pain was relieved completely in 8 joints, and the pain rating on a visual analog scale was 3.6 out of 10 for the 8 patients who had residual pain. Patients were satisfied completely with the results of 9 joints. Although there was residual deformity in 4 joints, patients believed that 15 of 16 joints had improved in appearance. Five of 6 patients responded that they would have the surgery again. There have been no secondary procedures performed by us. The insertion of pyrolytic carbon implants for PIPJ arthroplasty is a technically demanding procedure, but it has the potential to achieve pain relief, stability, satisfactory ROM, and correction of the deformity; however, the results in this review were unpredictable and may not be superior to those achieved with other methods of arthroplasty. Therapeutic, Level IV.

Total Knee Arthroplasty in Hemophilic Arthropathy of the Knee

Twenty-five total knee arthroplasties were performed in 21 patients with hemophilia. The mean patient age was 35.8 years and mean follow-up time was 6.2 years. The average preoperative knee score increased from 18.6 points (range, 3-29) to 82.8 points (range, 44-99). The average preoperative knee function score increased from 41.4 points (range, 20-60 points) to 75.8 points (range, 45-95 points). The average preoperative range of motion was 73.4° with an average flexion contracture of 22.6°, whereas the average postoperative range of motion increased to 92.2° with an average flexion contracture of 5.6°. Median consumption of coagulation factor concentrate decreased from 4837 U/month before operation to 1500 U/month 1 year after surgery. The total knee arthroplasty is a useful treatment in severe hemophilic arthropathy to obtain pain relief and functional improvement, and to reduce the need for ongoing treatment using coagulation factor concentrate.

Balancing severe valgus deformity in total knee arthroplasty using a lateral cruciform retinacular release

We report the technique and results of a cruciform lateral release performed on 35 consecutive knees having ≥15° of valgus with minimum 2-year follow-up. The posterior cruciate ligament (PCL) was preserved in all knees. Preoperative valgus averaged 17°, and range of motion averaged 10° to 107°. Postoperative valgus averaged 4.8°, and average postoperative range of motion was 2° to 110°. The PCL was partially released in 5 knees, and further lateral release of the lateral collateral ligament and popliteus were required in 3 knees. Stable flexion and extension gaps were achieved in all cases, and stability was maintained at follow-up. This lateral cruciform retinacular release provides a simple surgical technique for most valgus deformities of the knee and allows for stable ligamentous balancing.

Long-Term Results of Low Contact Stress Mobile-Bearing Total Knee Replacements

Five hundred ninety-eight consecutive primary low contact stress total knee replacements were done in 502 patients between 1985 and 1990. Clinical review was available for 495 knees (406 patients), 228 knees with meniscal-bearing prostheses and 267 knees with rotating-platform prostheses. The average followup was 12 years (range, 10-15 years). The average postoperative knee and functional scores were 87 points and 75 points, respectively. The average postoperative range of motion was 110 degrees. Fifty-six knees (11%) required revision for excessive wear of the tibial insert (41), dislocation (10), patellar polyethylene breakage (one), component loosening (one patellar, one tibial), and infection (two). During revision, osteolysis (20 knees), patellar polyethylene failure (33), and femoral component fracture (one) were seen. The overall survivorship was 88.1% at 15 years using Kaplan-Meier analysis. The survival rate was 83% for the meniscal-bearing prostheses and 92.1% for the rotating-platform prostheses. The Low Contact Stress mobile-bearing knee prosthesis has no superiority over that of fixed-bearing knees, especially for the meniscal-bearing design in prevention of polyethylene failure or revision. Based on the results of this study, the use of the LCS meniscal-bearing prosthesis does not appear to be justified.

高位けい骨骨切り術後の人工膝関節置換術の問題点

The results of 6 total knee arthroplasties (MG-I one joint, MG-II five joints) after high tibial osteotomy (HTO) were reviewed. The average age was 70.6 years (range, 61-82 years). The mean period from HTO to TKA was 95 months (range, 25-204 months). The average follow-up period after TKA was 17.5 months (range, 6-24 months). It was difficult to dislocate the patella from the femoral groove and retract it to the lateral aspect, so we osteotomized the tibial tuberosity in 4 cases. As the bone axis shifted to the medial side of the proximal tibia, it was difficult to mount a tibial component. In the patient treated with MG-I, the postoperative range of motion was -10-110 degrees, and the JOA score was 80 points. In patients using MG-II, the average postoperative range of motion was -1.0-96.0 degrees, and the average postoperative JOA score was 77.5 points (range, 70-80 points). There was no signifficant difference between these cases and other TKA cases.

Treatment of cysts of the acromioclavicular joint with shoulder hemiarthroplasty.

A chronic cyst overlying the acromioclavicular joint was managed in four patients, between July 1988 and September 1991. All patients had had previous unsuccessful aspiration and excision of the cyst with recurrence. Each cyst was associated with a chronic, massive defect of the rotator cuff; superior migration of the humeral head; and degenerative osteoarthrosis of the glenohumeral joint. All patients had complained of pain and limitation of motion (mean forward elevation, 95 degrees; mean external rotation, 20 degrees; and mean internal rotation, to the spinous process of the second lumbar vertebra). All procedures consisted of a large-humeral-head hemiarthroplasty, with no operative treatment directed at the cyst or the acromioclavicular joint. At an average of twenty-seven months (range, fifteen to thirty-six months) after the operation, the patients were all pain-free and had not had a recurrence of the cyst. The average postoperative range of motion was 130 degrees of forward elevation, 30 degrees of external rotation, and internal rotation to the spinous process of the first lumbar vertebra.

Four-bone ligament reconstruction for treatment of chronic complete scapholunate separation

This study reviews the results of a four-bone ligamentous weave reconstruction for treatment of chronic complete scapholunate separation. This reconstruction between the radius, lunate, capitate, and scaphoid employs a dorsal and palmar approach weaving a long strip of the extensor carpi radialis brevis through the four bones reducing and stabilizing the scaphoid and lunate with a wire loop. Thirty-six consecutive cases of operated chronic complete scapholunate separation were evaluated in a 2- to 10-year follow-up. Average length of follow-up was 4.8 years. Average age was 34 years. Average postoperative range of motion was 52 degrees extension and 37 degrees flexion. Grip strength averaged 73% of the noninvolved side. All preoperative scapholunate gaps seen on radiographs were greater than 4 mm, at surgery greater than 1.0 cm, and the postoperative gaps radiographically averaged 3.3 mm. Eighty-six percent of patients returned to preinjury activities including heavy labor. The most significant finding was no x-ray evidence of advancing arthritic changes.

The use of the McKeever metallic hemiarthroplasty for unicompartmental arthritis.

We reviewed the results of sixty-one McKeever unicompartmental arthroplasties performed by the senior one of us (T. P.) for osteoarthritis of the knee. The average follow-up was five years (range, two to thirteen years). Forty-four (72 per cent) of the arthroplasties were rated as good to excellent. The average postoperative range of motion in these knees was 110 degrees. Six knees were rated as fair and eleven knees, as poor. The poor results appeared to be caused by degenerative arthritis involving ipsilateral compartments that had not been resurfaced with an implant.

人工しつ関節置換術の治療成績

Three knees with geometric, seventeen with total condylar, two with Guepar, two with kinematic and one with ceramic prostheses were studied.The follow up period ranged from 6 months to 10 years with the average of 2.5 years.Pain was improved in all knees. In total condylar prosthesis, posterior subluxation of the tibia occurred in 40 percent. The average postoperative range of motion was slightly less than 100 degrees. Loosening and late infection was none. Our experience has led us to conclude that development of a new design is needed.

Supracondylar-intercondylar fractures of the femur treated with a supracondylar plate and lag screw.

Twenty-six patients ranging from nineteen to ninety-two years old underwent rigid internal fixation of supracondylar-intercondylar fractures of the distal end of the femur, using a supracondylar plate and lag screw to achieve two-plane fixation. The congruity of the articular surface of the knee was anatomically restored, as were the mechanical and anatomical axes of the lower extremity. The time to clinical and roentgenographic union averaged four months. There were no non-unions or postoperative infections. The average postoperative range of motion of the knee was 120 degrees. The average length of follow-up was twenty-one months. This series demonstrates the advantages of stable internal fixation using a supracondylar plate and lag screw over other types of fixation.

Arthroplasty of the elbow in rheumatoid arthritis.

The study consists of 208 elbow arthroplasties performed on rheumatoid arthritic patients. A straight resection of the joint was used in 53 cases and a modified Hass arthroplasty with skin interposition in 155 cases. The average postoperative range of motion in these groups was 100 degrees and 96 degrees respectively. Postoperatively the joint was painless in 81 and 67% of the elbows respectively. The Hass arthroplasty gave a better stability and extension power. The most common complications were paresthesias in the region of the ulnar nerve and bone resorption in the region of the ulnar nerve and bone resorption in the region of the olecranon fossa.