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Reconstructive Review

Journal Papers (9) Details Call for Paper Manuscript submission Publication Ethics Contact Authors' Guide Line
1 Early Learning Experience with a Neck Stabilized THA Stem for Treating Osteoarthritis, Timothy McTighe, Dr. H.S. (hc), Charles Bryant, MD, Declan Brazil, PhD, John Keggi, MD, Louis Keppler, MD
Total hip arthroplasty is one of the most effective orthopaedic procedures with a very high success rate as measured by pain relief, improved function and patient satisfaction. However, since the introduction of total hip arthroplasty in the 1940s, a range of design philosophies for femoral components have demonstrated variable clinical results. Aseptic loosening, joint dislocation, thigh pain, bone resorption and femoral component failure have been some of the complications that plague this procedure.1,2 The past few years has seen an influx of so-called short stems with very little clarification as to design features, required surgical technique and long-term clinical outcomes. Most devices, meet with some level of learning curve and most systems do little in the way of warning new surgeons as to the perils and pitfalls during the initial surgical phase. This paper is designed to review the lessons learned during the first year of surgical experience with a new neck stabilized implant stem.
2 Surgeon Interview on Current Trends in THA, Charles Bryant, MD, Louis Keppler, MD, John Keggi, MD, Corey Ponder, MD
3 Commentary on ?A Lack of Leadership Often Has? Unintended Results, Timothy McTighe, Dr. H.S. (hc)
Leadership has been described as the process of social influence in which one person can enlist the aid and support of others in the accomplishment of a common task".[1] Many have tried to define leadership and the qualities that make a Leader. One critical factor to recognize is the lack of leadership and the unintended results caused by this lack. This paper will reflect on my observations and opinions as to current situations and conditions in the orthopaedic health community as a result of a lack of leadership.
4 Failure Mechanism Revisited Total Knee Arthroplasty, Timothy McTighe, Dr. H.S. (hc), Declan Brazil, PhD, Ian Clarke, PhD, Louis Keppler, MD, John Keggi, MD, Robert Kennon, MD
Total Knee Arthroplasty (TKA) has become a well-established treatment modality for surgical correction of knee disorders and pain generated by arthritis and other disorders such as trauma. Today a patient can expect to rely on his new knee to serve him with comfort for a fair number of years if not his entire life. TKA has taken on a predicated level of confidence and certain trends have developed over the years. Success has increased demand and the health care system is challenged to meet current and growing demand for surgery [In fact, the epidemiological studies have predicted that hips will grow only a little whereas knees are projected to have a 6-fold increase - see Kutz AAOS Scientific Exhibit 2006]. Surgical techniques are specializing into specific indications or camps for specialized product features. Uni-compartmental, Bi-compartmental, Total Knee with and without replacement of the patella, along with Patella-femoral replacement are some of the product classifications now available. The near future is now with articular focal defect replacement. New materials and techniques will open this area to increased indications as the sport-medicine surgeon finds his way into this growing surgical market.
5 Clinical Evaluation of All Polyethylene Tibial Components in TKA -Review Paper, Declan Brazil, PhD, Timothy McTighe, Dr. H.S. (hc), John Keggi, MD, Louis Keppler, MD, Robert Kennon, MD
This review summarizes published literature that reports on clinical studies and/or randomized controlled trials from 1989 to end 2009 regarding the clinical performance history of several designs / brands of an all-polyethylene (AP) Tibial component used as part of a primary cemented Total Knee System implanted using established Total Knee Arthroplasty procedures. From the mid 1970s knee systems for replacement of knees diagnosed with osteoarthritis, rheumatoid (inflammatory) arthritis, osteonecrosis, avascular necrosis and other degenerative joint conditions used a plastic tibial component articulating on a chrome - cobalt femoral component. Resurfacing of the patella if required also used a plastic artificial patella button attached surgically with PMMA bone cement. Projections of increase in TKA of +600% increase in annual surgeries over the next 15 years has focused significant interest in reconsideration of using this style tibial component in the growing elderly population. Key Words: Total Knee Arthroplasty, polyethylene, tibial component, clinical performance
6 Clinical Review of the Zweymuller Femoral Stem, Christian Wright, BS, Dale Lambert, BS, Declan Brazil, PhD, Kristaps Keggi, MD, John Keggi, MD, Timothy McTighe, Dr. H.S. (hc)
This review summarizes published literature from a range of reputable sources regarding hip prostheses (stems) utilized currently in cementless Total Hip Arthroplasty. The critical review of published clinical studies shows Zweymuller style (Alloclassic and SL-Plus) stems in all critical characteristics. Since the introduction of cementless total hip arthroplasty in the 1970s, a range of design philosophies for femoral and acetabular components have demonstrated variable clinical success1,3. Recently cementless components have been yielding clinical results on par and in some cases even surpassing their cemented predecessors2,4,6. As a result, cementless THA is gaining in popularity1,7. The short-term results of four of the best cementless femoral components recorded in the Norwegian Arthroplasty Register as described by Havelin et al, included the Corail, lMT, Profile and Zweymuller stems with revision for loosening
7 Deactivation of Palacos R Bone Cement with the Addition of Rifampin Antibiotic Powder An In-Vivo Experience -Case Report, Edward McPherson, MD FACS
Use of antimicrobial impregnated polymethylmethacrylate (PMMA) bone cement in the treatment of orthopaedic infections is widely accepted.1 Antibiotic powder is routinely added to PMMA, and formed into beads or spacers when treating infected bone or periprosthetic infections. Antibiotics placed into the PMMA elute via a water diffusion process.2 This results in high local doses of the antimicrobial agent with reduced systemic toxicity.3 Two stage reimplantation protocols utilizing antibiotic loaded PMMA cement generally provide the highest rates of successful treatment.4,5 With the increasing number of resistant organisms, success of this treatment protocol requires antimicrobial therapy targeted at the specific organism found. There exists a great deal of data on the use of certain antimicrobial agents in PMMA cement.1,6,7 However, there are few published reports of the addition of rifampin. This is the first clinical report on the failure of Palacos R cement (Heraeus Kulzer GmbH, Wehrheim, Germany) to set when rifampin is added.
8 Design Rationale and Early Clinical / Surgical Observations with a Short Curved Tissue Sparing Hip Implant The Apex ARC Stem, Timothy McTighe, Dr. H.S. (hc), Declan Brazil, PhD
Architectural changes occurring in the proximal femur (resporption) after THA (due to stress shielding) continues to be a problem1,2,3,4,5,12. Proximal stress shielding occurs regardless of fixation method (cement, cementless). The resultant bone loss can lead to implant loosening and or breakage of the implant. We are seeing younger patients with higher levels of physical activity as compared to just a decade ago. This has brought back a renewed interest in hip resurfacing along with significant interest in minimally invasive surgical approaches and smaller profile implants. Tissue sparing surgery in THA is credited to Prof. Pipino, from Monza, Italy who has been working on this concept for over 30 years6.The Apex ARC Stem is built off the pioneering work of Pipino, Freeman, Townley and Whiteside with new novel design features. In this paper, we review design rationale, surgical technique, clinical impressions, learning curves and lessons learned to-date. In particular, our first 650 stems have been implanted, with 500 being reviewed by the posted surgical team over the past 16 months. Key Words: Total Hip Arthroplasty, tissue sparing, neck preserving, neck stabilize
9 FEA Analysis of Neck Sparing Versus Conventional Cementless Stem, Declan Brazil, PhD Timothy McTighe, Dr. H.S. (hc)
Finite element analysis is a valuable tool in prosthetic design and helps predict specific mechanical behaviors between mechanical testing and clinical observations1. We have studied the effect of tensile stresses of both conventional length stems with conventional neck resections and compared them to a novel short curved neck sparing tissue preserving stem design and have found correlation between FEA modeling and plain radiographics. Neck sparing stem with a novel conical flair does improve bio-mechanical conditions in THA as compared to conventional length cementless stems.