David G. Chess

Patellar position after total knee arthroplasty: Influence of femoral component malposition

Patellar shift, tilt, and rotation were analyzed in 7 cadaveric knee specimens during simulated quadriceps loading, in the intact knee, and after implant reconstruction. Femoral component medialization, lateralization, and external rotation were also investigated. Relative motion of the patella with respect to the femur was measured using an electromagnetic tracking system. The spatial position of the patella did not change with standardized total knee arthroplasty (P <.05). After malpositioning of the femoral component, patellar rotation also did not change (P >.05); however, patellar tilt was altered by femoral component external rotation malposition (P <.05), and patellar shift was affected by all femoral component malpositions (P <.05). The spatial position of the patella relative to the femoral shaft was changed with any femoral component malposition, suggesting that the soft tissues were abnormally tensioned. This could result in subsequent wear on the patellar component and, therefore, early failure.

Advanced cement technique improves fixation in elbow arthroplasty.

An in vitro study was conducted to assess the efficacy of advanced cementing techniques in the fixation of the humeral stem in elbow arthroplasty. Sixteen fresh frozen cadaveric distal humeri were prepared to accept an acrylic sham humeral stem. Conventional cementing technique using doughy cement manually inserted and packed was performed in 8 specimens. The advanced cementing technique, consisting of canal irrigation, brushing and drying with gauze, canal plugging, and low viscosity cement pressurization with a delivery system was performed in the other specimens. All humeri subsequently were sectioned into 10 mm thick sections, photographed, and digitized to quantify the perimeter and area of the stem, cement mantle, corticocancellous junction, and cement voids. The degree of cement filling, determined from the area fraction of cement to the total available area within the corticocancellous junction, was significantly greater in the advanced group compared with the conventional group. Mechanical assessment of the specimens consisted of a push out load to failure test of the cement mantle from bone. For all locations in the distal humerus, the failure load and failure stress in the advanced group was significantly greater than the conventional group. It is concluded that development of an effective cement restrictor and application of advanced cement techniques in vivo should improve the initial fixation of the humeral component and may decrease the incidence of aseptic loosening associated with elbow arthroplasty.

Does keel size, the use of screws, and the use of bone cement affect fixation of a metal glenoid implant?

The objective of this study was to determine the effect of screws and keel size on the fixation of an all-metal glenoid component. A prototype stainless-steel glenoid component was designed and implanted in 10 cadaveric scapulae. A testing apparatus capable of producing a loading vector at various angles, magnitudes, and directions was used. The independent variables included six directions and three angles of joint load, and five fixation modalities-three different-sized cross-keels (small, medium, and large), screws, and bone cement. Implant micromotion relative to bone was measured by four displacement transducers at the superior, inferior, anterior, and posterior sites. The components displayed a consistent response to loading of ipsilateral compression and contralateral distraction. Use of progressively larger keels did not significantly improve implant stability. Stability decreased as the angle of load application increased (P <.05). Screw and cement fixation resulted in the most stable fixation (P <.05).

Load relaxation and forces with activity in hoffman external fixators: A clinical study in patients with Colles' fractures

A small-frame Hoffman external fixation bar instrumented with strain gauges to quantify bending and torsional forces was applied to 4 patients with a displaced metaphyseal fracture of the distal radius. Measurements were taken during surgery as well as at 1, 3, and 6 weeks after surgery during activities of daily living and hand therapy mobilization. Radiographs also were taken before and after reduction and at each subsequent visit. Force decay occurred after reduction of the fracture, averaging only 26% of the initial distraction forces by 5 minutes. These forces plateaued and did not significantly change over the subsequent 40-minute observation period. There was no correlation between carpal height index and the forces measured in the external fixator. Significant changes in external fixator forces were measured during activities of daily living and hand therapy mobilization, but these returned to baseline after the activities were performed. The most provocative activities studied were twisting a doorknob and lifting heavy objects. These activities should be performed with caution by patients with unstable distal radial fractures.

A biomechanical analysis of intrascaphoid compression using the 3.00 mm Synthes cannulated screw and threaded washer: an in vitro cadaveric study.

This study evaluated the compressive capabilities of the 3.0mm Synthes cannulated screw and threaded washer. A transverse osteotomy was performed at the waist of eight cadaveric scaphoids and a custom-designed load cell was inserted before internal fixion with a 3.0mm cannulated screw and threaded washer. The mean intrascaphoid compression achieved was 108 (SD, 60) N. This compressive force is comparable to that produced by standard cortical screws.

Design and validation of an unconstrained loading system to measure the envelope of motion in the rabbit knee joint.

An unconstrained loading system was developed to measure the passive envelope of joint motion in an animal model commonly used to study ligament healing and joint arthritis. The design of the five-degree-of-freedom system allowed for unconstrained knee joint loading throughout flexion with repeated removal and reapplication of the device to a specimen. Seven New Zealand White rabbit knees were subjected to varus, valgus, internal and external loads, and the resulting envelopes of motion were recorded using an electromagnetic tracking device. Intra-specimen reproducibility was excellent when measured in one specimen, with maximal rotational differences of 0.6 and 0.3 deg between the fourth and fifth testing cycles for the varus (VR) and valgus (VL) envelopes, respectively. Similarly, the maximal internal (INT) and external (EXT) envelope differences were 0.5 and 0.4 deg, respectively, between the fourth and fifth cycles. Good inter-animal envelope reproducibility was also observed with consistent motion pathways for each loading condition. A maximal VR-VL laxity of 17.9 +/- 2.3 deg was recorded at 95 deg flexion for the seven knees tested. The maximal INT-EXT laxity of 75.2 +/- 4.8 deg occurred at 50 deg flexion. Studies on measurement reproducibility of re-applying individual testing components demonstrated a maximal error of 1.2 +/- 0.7 deg. Serial removal and re-application (test-retest) of the complete measuring system to one cadaveric knee demonstrated maximal envelope differences of less than 0.7 deg for VR-VL rotation and 2.1 deg for INT-EXT rotation. Our results demonstrate that the measuring system is reproducible and capable of accurate evaluation of knee joint motion. Baseline in vitro data were generated on normal joint kinematics for future in-vivo studies with this system, evaluating ligament healing and disease progression in arthritis models.