Richard N. Stauffer

Anterior Interbody Lumbar Spine Fusion: Analysis Of Mayo Clinic Series

A consecutive series of eighty-three patients treated with anterior interbody disc excision and bone-grafting has been presented. A good clinical result was achieved by only 36 per cent of the patients and roentgenographic evidence of fusion at all levels grafted occurred in only 56 per cent. A one-level grafting procedure gave a better chance of fusion (68 per cent) and the lumbosacral interspace became solid slightly more frequently than more cephalad interspaces. Postoperative cast immobilization significantly improved the fusion rate. We concluded that the reported differences in success with this technique are attributable chiefly to the interpretation of clinical and roentgenographic factors by different authors and to the type of patients selected for this procedure. We believe that this technique should be utilized as a salvage procedure only in those infrequent cases in which posterolateral grafting is inadvisable because of infection or unusally extensive scarring.

Force and motion analysis of the normal, diseased, and prosthetic ankle joint.

A 2-dimensional motion and force study of the ankle joint during gait has been carried out on normal subjects and patients with ankle joint disease, before and 1 year following total ankle replacemetn. The methods employed involved the use of high-speed motion picture film, force plate and foot-switch data. The Achilles and anterior tibial tendon forces, the compressive and tangential (shear) forces across the ankle during stance phase of gait were determined, based on a quasi-static analysis. During stance phase of gait normal subjects used a mean of 24.4 degree of sagittal plane ankle motion. Patients with ankle joint disease showed reduced motion which returned to near normal values 1 year following total ankle replacement. Compressive force across the ankle joint rose to about 5 times body weight during the latter part of stance phase. Backward, or aft, shear forces or nearly full body weight were demonstrated during all but the last 20% of stance phase. Patients with ankle joint disease apparently altered their gait to markedly reduce these forces. Following total ankle replacement, shear forces returned toward more normal values, but compressive forces were not significantly changed.

Posterolateral Lumbar-spine Fusion: Analysis Of Mayo Clinic Series

A series of 177 patients who had posterolateral lumbar-spine bone-grafting has been presented. The clinical result was based on reliefof pain, the need for analgesic medication, the restriction of physical activities, and the return to employment. Sixty per cent achieved good results, and 81 per cent satisfactory results (good and fair). A solid fusion based on roentgenographic evaluation was achieved in 80 per cent. There was high correlation between the clinical result and the presence or absence of a solid fusion in all diagnostic categories except spondylolisthesis. For spondylolisthesis, a one-level posterolateral grafting procedure seemed to be more reliable than a two-level procedure. Compensation considerations and a diagnosed psychoneurosis were factors that were identified as predisposing to a poor clinical result. Postoperative immobilization with a plaster body cast did not improve the fusion rate. Our experience indicates that posterolateral lumbar-spine bone-grafting resulted in a better fusion rate and a greater percentage of good clinical results than those reported for either anterior interbody or strictly posterior bone-grafting techniques.

Charnley total hip arthroplasty with cement. Fifteen-year results.

The results of the first 333 Charnley total hip arthroplasties that were performed with cement at the Mayo Clinic were reviewed a minimum of fifteen years postoperatively. Data were available for 166 of 170 hips of patients who were still alive. One hundred and thirty patients died, and thirty-seven hips were revised. At the time of this study, 80 per cent of the living patients had no pain, and 152 of the 160 hips remained much better than before the operation. Kaplan-Meier analysis of probable loosening of one or both components, on the basis of roentgenographic evidence, demonstrated a probability of loosening of 3 per cent incidence at one year after operation, 13 per cent at five years, 19 per cent at ten years, and 32 per cent at fifteen years. The probability of failure (that is, revision or symptomatic loosening) was 0.9 per cent at one year, 4.1 per cent at five years, 8.9 per cent at ten years, and 12.7 per cent at fifteen years. We did not identify a dramatic increase in the incidence of loosening or failure at any of the follow-up periods (one, five, ten, or fifteen years). With the Mayo Clinic clinical and roentgenographic system for scoring the hips, we found that ninety-seven hips had a good or excellent result; fifteen, a fair result; and thirteen, a poor result. (The scoring could not be completed for forty-one hips). The functional results deteriorated slightly over time.(ABSTRACT TRUNCATED AT 250 WORDS)

Biomechanical gait analysis of the diseased knee joint.

Clinical and roentgenographic examinations do not provide objective information on the functional performance of a diseased knee joint. In the present study, biomechanical parameters of knee joint function for 95 patients (162 knees) with rheumatoid arthritis and degenerative joint disease were studied in a gait laboratory and compared with those for 29 normal subjects. Gait abnormalities of the patient groups were significant and were related more to the functional status of the knee than to patient age and sex or the specific diagnosis. Knee joint disease produced an inefficient gait that seemed to mitigate joint pain (by reducing poorly tolerated compressive forces on the joint) and to increase proprioceptive feedback (in order to increase dynamic muscular control of the unstable joint). Biomechanical parameters were statistically correlated with some clinical and roentgenographic features to allow standardization of functional assessment of the diseased knee joint.

Cemented total hip arthroplasty with contemporary techniques. A five-year minimum follow-up study.

A retrospective clinical and roentgenographic review was performed on 251 consecutive cemented total hip arthroplasties (THA) performed from 1978 to 1980 that had been followed a minimum of five years (range, five to seven years). All arthroplasties involved the use of a Harris Design II femoral stem, an intramedullary plug, a cement gun, and pulsatile lavage of both the acetabulum and the femoral canal. At the final follow-up examination, 98% of the patients had excellent results. The average Harris hip score was 47 points preoperative and 97 points postoperative. There were three definitely loose femoral stems, one probably loose, and two possibly loose. There was one loose acetabular component, no revisions or operations were performed. When comparing this series with a similar study, there were statistically improved results in all parameters. Results from this study of cemented THAs using contemporary techniques and prosthetic stem design represent the standard for comparison when evaluating alternative THA systems.

Total Ankle Arthroplasty: Four Years?? Experience

A review of 102 total ankle arthroplasties performed during a four-year period revealed that complications occurred in 41%. 22% with impingement of various types 6.9% with loosening and 2.9% with deep sepsis. The best results were obtained in patients with rheumatoid arthritis and those with posttraumatic osteoarthritis who were older than 60 years of age. Total ankle arthroplasty currently should not be considered in patients with posttraumatic osteoarthritis who are younger than 60 years old. Arthrodesis remains the only acceptable method of treatment in these individuals. Total ankle arthroplasty seems indicated in patients who have significant ankle joint disability secondary to rheumatoid arthritis and in elderly patients with disabling posttraumatic degeneration whose physical demands are limited.

Fixed-head and bipolar hip endoprostheses: A retrospective clinical and roentgenographic study

A retrospective review of 1,001 hip hemiarthroplasties was performed. The prosthetic designs were grouped into fixed-head types (682 cases) and bipolar types (319 cases) for comparison. The main indications for operation were femoral neck fracture and avascular necrosis of the femoral head. Clinical and roentgenographic data for different follow-up periods were compared between prosthetic types, using multivariate analysis. Roentgenographic loosening of the femoral component was noted in 25.4% of cases but was significantly higher (P less than .05) in the bipolar groups for a follow-up period less than 2 years, regardless of the method of fixation. The acetabular erosion rate was significantly higher (P less than .05) in the fixed head group, but this finding was related to length of follow-up period, bone porosity, and prosthesis/acetabulum fit. The reoperation rate, including revision to total hip arthroplasty, was higher in the fixed-head group (12.5%) than the bipolar group (7.2%). Based on Kaplan-Meier survivorship analysis, 13.7% of the bipolar and 22.9% of the fixed-head hip endoprostheses are expected to be reoperated 8 years after initial implantation. Cement fixation of the femoral component led to a higher prosthesis survival rate, regardless of type. Both prosthetic types are useful in hip surgery, but the bipolar type appears to be indicated in younger and more active patients, whereas the fixed-head design is more suitable for older patients with femoral neck fractures.

Rates of Total Hip Arthroplasty: A Population-Based Study

Three hundred eighty-one total hip arthroplasties were performed on residents of Olmsted County, Minnesota, during the period from 1969 to 1980, for a rate (adjusted for sex and age) of 44.6 per 100,000 person-years. Rates rose with age, were higher for women than men, and were higher among urban than rural residents of the county. If we assume that the Olmsted County experience is medically optimal and apply it to the 1980 United States population, we calculate a national requirement of over 100,000 total hip arthroplasties per year, well above the current actual figure. If this calculated number of total hip arthroplasties were actually performed each year, over 1.4 million hospital days would be required, and direct medical costs would probably exceed

Management of hip fractures by total hip arthroplasty.

1 billion annually.