This is a retrospective review of two series of using the same stem and modular neck design (R-120™) with the exception that the second series had an improved modular neck construct. Model I, 145 stems implanted between 2002 and 2005. Taper neck problems consisted of two neck trunion fractures at the neck stem junction and one modular neck disassociation at the modular junction. Stem was withdrawn from the market and redesigned to a more robust structure. Model II, 188 stems were implanted between 2007 and 2011 by the senior author utilizing the same surgical technique. There have been no modular neck taper problems. This paper will demonstrate that once a modular junction problem has been identified corrective action can be taken to resolve the problem. We advocate that there is a benefit to a modular neck cemented stem design and all modular junctions are not equal in design or function.
{"title":"Experience with Modular Necks for Cemented Total Hip Arthroplasty","authors":"H. Cameron, T. Mctighe","doi":"10.15438/RR.6.1.132","DOIUrl":"https://doi.org/10.15438/RR.6.1.132","url":null,"abstract":"This is a retrospective review of two series of using the same stem and modular neck design (R-120™) with the exception that the second series had an improved modular neck construct. Model I, 145 stems implanted between 2002 and 2005. Taper neck problems consisted of two neck trunion fractures at the neck stem junction and one modular neck disassociation at the modular junction. Stem was withdrawn from the market and redesigned to a more robust structure. Model II, 188 stems were implanted between 2007 and 2011 by the senior author utilizing the same surgical technique. There have been no modular neck taper problems. This paper will demonstrate that once a modular junction problem has been identified corrective action can be taken to resolve the problem. We advocate that there is a benefit to a modular neck cemented stem design and all modular junctions are not equal in design or function.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67682206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Pourmoghaddam, M. Dettmer, Stefany J. K. Malanka, S. Kreuzer
Total knee arthroplasty is used as the treatment plan for patients with end-stage osteoarthrosis associated with severely affected function. Although TKA has been used for many years, some patients have reported overall dissatisfaction regarding the outcome. This may be due to the complexity of the joint design. In recent years, the concept of single-radius knee prosthetics is gaining more popularity as many studies have discussed biomechanical and clinical benefits of such design compared to traditionally used multi-radius implants. In this study, we report the outcome of 78 patients who were treated by TKA utilizing a relatively new single-radius implant, Unity. Results showed that all subjects reported good outcomes as expressed by significant improvement in their Knee Injury and Osteoarthritis Outcome Scores at 1-year post-operative. The symptom, pain, and ADL subscores demonstrated significant improvement in patients with scores twice the pre-operative value, while the average improvement in sport and quality of life subscores showed even greater improvement with scores three times the pre-operative value.
{"title":"Comparison of Functional Outcomes of Total Knee Arthroplasty Using Two Different Single Radius Implants","authors":"A. Pourmoghaddam, M. Dettmer, Stefany J. K. Malanka, S. Kreuzer","doi":"10.15438/RR.6.1.134","DOIUrl":"https://doi.org/10.15438/RR.6.1.134","url":null,"abstract":"Total knee arthroplasty is used as the treatment plan for patients with end-stage osteoarthrosis associated with severely affected function. Although TKA has been used for many years, some patients have reported overall dissatisfaction regarding the outcome. This may be due to the complexity of the joint design. In recent years, the concept of single-radius knee prosthetics is gaining more popularity as many studies have discussed biomechanical and clinical benefits of such design compared to traditionally used multi-radius implants. In this study, we report the outcome of 78 patients who were treated by TKA utilizing a relatively new single-radius implant, Unity. Results showed that all subjects reported good outcomes as expressed by significant improvement in their Knee Injury and Osteoarthritis Outcome Scores at 1-year post-operative. The symptom, pain, and ADL subscores demonstrated significant improvement in patients with scores twice the pre-operative value, while the average improvement in sport and quality of life subscores showed even greater improvement with scores three times the pre-operative value.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67682326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Manthe, Kurt E. Blasser, C. Beauchamp, M. O’Connor
We describe nine patients who had total hip arthroplasty failure [titanium alloy monolithic stem, cobalt-chromium head (32 mm or 36 mm), highly cross-linked polyethylene liner, metal socket] related to metal wear debris generated at the trunnion. Symptoms included pain with onset 2.9 years after THA. Preoperative serum cobalt metal ion levels were elevated [mean 8.8 ng/ml (normal < 0.9 ng/ml)] and were higher than chromium levels [mean 1.2 ng/ml (normal < 0.3 ng/ml)]. All patients had debridement of the periarticular soft tissues, stem retention, revision to ceramic head and new liner; two patients had acetabular revision. At early follow-up, 7 of 8 available patients did well, with improved cobalt (0.6 ng/ml) and little change in chromium levels. We recommend heightened awareness regarding this mode of failure.
{"title":"Trunnion Corrosion causing Failure in Metal-on-Polyethylene Total Hip Arthroplasty with Monolithic Femoral Components","authors":"M. Manthe, Kurt E. Blasser, C. Beauchamp, M. O’Connor","doi":"10.15438/RR.6.1.131","DOIUrl":"https://doi.org/10.15438/RR.6.1.131","url":null,"abstract":"We describe nine patients who had total hip arthroplasty failure [titanium alloy monolithic stem, cobalt-chromium head (32 mm or 36 mm), highly cross-linked polyethylene liner, metal socket] related to metal wear debris generated at the trunnion. Symptoms included pain with onset 2.9 years after THA. Preoperative serum cobalt metal ion levels were elevated [mean 8.8 ng/ml (normal < 0.9 ng/ml)] and were higher than chromium levels [mean 1.2 ng/ml (normal < 0.3 ng/ml)]. All patients had debridement of the periarticular soft tissues, stem retention, revision to ceramic head and new liner; two patients had acetabular revision. At early follow-up, 7 of 8 available patients did well, with improved cobalt (0.6 ng/ml) and little change in chromium levels. We recommend heightened awareness regarding this mode of failure.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67682053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Burch-Schneider cages are often used for the treatment of acetabular bone defects. In several clinical studies these cages have shown good mid- to long-term results. However, a higher failure rate has been reported in large Paprosky IIIB defects compared with smaller Paprosky II-IIIA defects. This study aims to investigate the effect of cage support on cage failure by means of finite element analysis. The Von Mises stresses in both the implant and the bone are analyzed for a Burch-Schneider cage used in the following scenarios: (1) a large acetabular bone defect, (2) a small acetabular bone defect and (3) a large acetabular bone defect in combination with a reinforcement plate. The results show that implant and bone stresses are higher in the large defect (99 th percentile of 146.6 and 73.5 MPa respectively) than in the small defect (99 th percentile of 43.9 and 47.9 MPa respectively). Adding a reinforcement plate to posteriorly support the cage decreases the stresses but not fully compensates for the missing bone support (99 th percentile of 93.1 and 55.3 MPa respectively). Since high stresses cause an increased risk for fatigue failure and implant loosening, sufficient implant support is required to reduce the risk of cage failure.
{"title":"Stress analysis of a Burch-Schneider cage in an acetabular bone defect: A case study","authors":"K. Plessers, H. Mau","doi":"10.15438/RR.6.1.141","DOIUrl":"https://doi.org/10.15438/RR.6.1.141","url":null,"abstract":"Burch-Schneider cages are often used for the treatment of acetabular bone defects. In several clinical studies these cages have shown good mid- to long-term results. However, a higher failure rate has been reported in large Paprosky IIIB defects compared with smaller Paprosky II-IIIA defects. This study aims to investigate the effect of cage support on cage failure by means of finite element analysis. The Von Mises stresses in both the implant and the bone are analyzed for a Burch-Schneider cage used in the following scenarios: (1) a large acetabular bone defect, (2) a small acetabular bone defect and (3) a large acetabular bone defect in combination with a reinforcement plate. The results show that implant and bone stresses are higher in the large defect (99 th percentile of 146.6 and 73.5 MPa respectively) than in the small defect (99 th percentile of 43.9 and 47.9 MPa respectively). Adding a reinforcement plate to posteriorly support the cage decreases the stresses but not fully compensates for the missing bone support (99 th percentile of 93.1 and 55.3 MPa respectively). Since high stresses cause an increased risk for fatigue failure and implant loosening, sufficient implant support is required to reduce the risk of cage failure.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67682761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: To evaluate the efficacy of a multimodal venous thromboembolism (VTE) prophylaxis including preoperative thrombophilia screening for total hip and knee arthroplasties (THAs and TKAs) and to consider the possibility of utilizing thrombophilic blood markers for preoperative identification of patients with high risk for VTE.. Method: The physical evaluation, involving the medical history of previous VTE, recent malignancy, and preoperative prolonged immobility status, and the existence of deep venous thrombosis (DVT) detected by duplex venous ultrasonography were assessed. Then, the patients with high risk of VTE were offered an inferior vena cava (IVC) filter preoperatively. The laboratory examination of complete blood count and standard biochemistry with factor VIII, activated protein C resistance (APCR), and prothrombin gene mutation were also measured. The operations were performed under regional anesthesia in most cases, and with venous foot pump (VFP), and early mobilization and aspirin (325 mg) daily were applied postoperatively. Results: IVC filters were placed in 6, and acute DVT was detected in 5 of the total 99 cases. However, there was no critical bleeding or fatal VTE. In the blood markers, prothrombin mutation and factor VIII seemed to have a relation to DVT. Conclusion: The efficacy of our multimodal protocol was confirmed. Further research is necessary to apply factor VIII and prothrombin gene mutation as thrombophilic blood markers.
{"title":"Multimodal Venous Thromboembolism Prophylaxis with Preoperative Thrombophilia Screening Examinations for Total Hip and Knee Arthroplasties","authors":"Y. Oshima, J. Fetto","doi":"10.15438/RR.5.4.117","DOIUrl":"https://doi.org/10.15438/RR.5.4.117","url":null,"abstract":"Objective: To evaluate the efficacy of a multimodal venous thromboembolism (VTE) prophylaxis including preoperative thrombophilia screening for total hip and knee arthroplasties (THAs and TKAs) and to consider the possibility of utilizing thrombophilic blood markers for preoperative identification of patients with high risk for VTE.. Method: The physical evaluation, involving the medical history of previous VTE, recent malignancy, and preoperative prolonged immobility status, and the existence of deep venous thrombosis (DVT) detected by duplex venous ultrasonography were assessed. Then, the patients with high risk of VTE were offered an inferior vena cava (IVC) filter preoperatively. The laboratory examination of complete blood count and standard biochemistry with factor VIII, activated protein C resistance (APCR), and prothrombin gene mutation were also measured. The operations were performed under regional anesthesia in most cases, and with venous foot pump (VFP), and early mobilization and aspirin (325 mg) daily were applied postoperatively. Results: IVC filters were placed in 6, and acute DVT was detected in 5 of the total 99 cases. However, there was no critical bleeding or fatal VTE. In the blood markers, prothrombin mutation and factor VIII seemed to have a relation to DVT. Conclusion: The efficacy of our multimodal protocol was confirmed. Further research is necessary to apply factor VIII and prothrombin gene mutation as thrombophilic blood markers.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67682011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Arthritis in the knee is a leading cause of pain and disability with total knee arthroplasty (TKA) often the treatment of choice after failure of more conservative treatments. TKA has been demonstrated to be one of the most successful procedures performed. However, despite the good long-term survivorship rates, patient satisfaction is still an issue post TKA with over 20% of patients exhibiting patient dissatisfaction most commonly due to anterior knee pain (over 18-28% patients) and mediolateral or varus-valgus instability. Recent studies have demonstrated that collateral ligament strains are altered post TKA which may lead to laxity and/or tightness of the ligaments resulting in patient discomfort, pain, stiffness and/or instability post TKA. As a result, it may be beneficial to ensure ligamentous strains after TKA are similar or close to the native situation. The purpose of this study was to evaluate the clinical and radiographic results of the Unity Knee™ Total Knee System (Corin Ltd, Cirencester, UK), a modern generation, single-radius total knee replacement (TKR) and its accompanying instrumentation which is designed to help maintain proper ligament balance and restore the medial jointline. A total of 89 knees (89 patients) were implanted with the device in a single surgeon series. All patients were assessed using the American Knee Society Score (AKSS), the Oxford Knee Score (OKS), and radiographs. There was 1 revision due to infection and Kaplan-Meier survivorship was 98.9% at 2 years. The mean AKSS knee score for the total cohort was 87.1 ± 7.98 and the mean Oxford Knee score was 45.89 + 3.69. Radiographic review found no signs of radiographic failure in any of the knees. This study demonstrates good survivorship, clinical, and radiographic results at 2 years for this TKR.
{"title":"Early Experience with a Modern Generation Knee System: Average 2 Years’ Follow-up","authors":"T. Paszicsnyek","doi":"10.15438/RR.5.4.125","DOIUrl":"https://doi.org/10.15438/RR.5.4.125","url":null,"abstract":"Arthritis in the knee is a leading cause of pain and disability with total knee arthroplasty (TKA) often the treatment of choice after failure of more conservative treatments. TKA has been demonstrated to be one of the most successful procedures performed. However, despite the good long-term survivorship rates, patient satisfaction is still an issue post TKA with over 20% of patients exhibiting patient dissatisfaction most commonly due to anterior knee pain (over 18-28% patients) and mediolateral or varus-valgus instability. Recent studies have demonstrated that collateral ligament strains are altered post TKA which may lead to laxity and/or tightness of the ligaments resulting in patient discomfort, pain, stiffness and/or instability post TKA. As a result, it may be beneficial to ensure ligamentous strains after TKA are similar or close to the native situation. The purpose of this study was to evaluate the clinical and radiographic results of the Unity Knee™ Total Knee System (Corin Ltd, Cirencester, UK), a modern generation, single-radius total knee replacement (TKR) and its accompanying instrumentation which is designed to help maintain proper ligament balance and restore the medial jointline. A total of 89 knees (89 patients) were implanted with the device in a single surgeon series. All patients were assessed using the American Knee Society Score (AKSS), the Oxford Knee Score (OKS), and radiographs. There was 1 revision due to infection and Kaplan-Meier survivorship was 98.9% at 2 years. The mean AKSS knee score for the total cohort was 87.1 ± 7.98 and the mean Oxford Knee score was 45.89 + 3.69. Radiographic review found no signs of radiographic failure in any of the knees. This study demonstrates good survivorship, clinical, and radiographic results at 2 years for this TKR.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67681574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Modular femoral heads have been used successfully since the mid-1980s in total hip arthroplasty. The use of metallic modular junctions presents a unique set of advantages and problems for use in total hip arthroplasty (THA). The separation of the head from the stem by a Morse taper has provided many benefits on the precision and balancing the reconstructed joint. Historically few complications have been reported for the modular Morse taper connection between the femoral head and trunnion of the stem in metal-on-polyethylene bearings. However, the risks or concerns are a little harder to identify and deal with. Certainly corrosion, and fatigue failure are the two most prevalent concerns but now the specifics of fretting wear and corrosive wear increasing particulate debris and the potential biological response is having an impact on the design and potential longevity of the reconstructed hip. This paper is dealing with a simpler consequence of head/stem modularity. Modular head mismatch to the socket bearing articulation. Two patients by two different surgeons at two different hospitals underwent cementless THA. Both patients were female and both presented with degenerative changes to the hip articulation. Both patients underwent hip replacement via a direct anterior approach using a standard hemispherical porous coated shell. One patient had a ceramic on ceramic bearing and the other had a ceramic head on a polyethylene liner. Both patients had a 32 mm inside diameter liner implanted and both had a 36 mm ceramic femoral head. The ceramic on ceramic mismatch was not recognized until the second office visit at eight weeks. The ceramic poly mismatch was not recognized until first office visit at six weeks. Both underwent correction surgery. These two cases demonstrate human mistakes can be made and steps need to be established to prevent future mistakes of this nature.
{"title":"Modular Head Mismatch in THA","authors":"T. Mctighe","doi":"10.15438/RR.5.4.128","DOIUrl":"https://doi.org/10.15438/RR.5.4.128","url":null,"abstract":"Modular femoral heads have been used successfully since the mid-1980s in total hip arthroplasty. The use of metallic modular junctions presents a unique set of advantages and problems for use in total hip arthroplasty (THA). The separation of the head from the stem by a Morse taper has provided many benefits on the precision and balancing the reconstructed joint. Historically few complications have been reported for the modular Morse taper connection between the femoral head and trunnion of the stem in metal-on-polyethylene bearings. However, the risks or concerns are a little harder to identify and deal with. Certainly corrosion, and fatigue failure are the two most prevalent concerns but now the specifics of fretting wear and corrosive wear increasing particulate debris and the potential biological response is having an impact on the design and potential longevity of the reconstructed hip. This paper is dealing with a simpler consequence of head/stem modularity. Modular head mismatch to the socket bearing articulation. Two patients by two different surgeons at two different hospitals underwent cementless THA. Both patients were female and both presented with degenerative changes to the hip articulation. Both patients underwent hip replacement via a direct anterior approach using a standard hemispherical porous coated shell. One patient had a ceramic on ceramic bearing and the other had a ceramic head on a polyethylene liner. Both patients had a 32 mm inside diameter liner implanted and both had a 36 mm ceramic femoral head. The ceramic on ceramic mismatch was not recognized until the second office visit at eight weeks. The ceramic poly mismatch was not recognized until first office visit at six weeks. Both underwent correction surgery. These two cases demonstrate human mistakes can be made and steps need to be established to prevent future mistakes of this nature.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67682362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Berend, J. Hurst, M. Morris, Joanne B. Adams, A. Lombardi
Redesigned instrumentation has become available for implantation of the Oxford Mobile Bearing Medial unicompartmental knee arthroplasty. To assess the benefit of these changes, we compared operative time of 200 Phase III and 176 Microplasty UKA done 2008-2011. An average time savings of 8.6 minutes was seen with the Microplasty design. Additionally, the standard deviation in operative times, minimum and maximum operatives were lower in knees in which Microplasty instrumentation was utilized. A 15% savings in operative time was seen with the new Microplasty instrumentation.
{"title":"New Instrumentation Reduces Operative Time in Medial Unicompartmental Knee Arthroplasty Using the Oxford Mobile Bearing Design","authors":"K. Berend, J. Hurst, M. Morris, Joanne B. Adams, A. Lombardi","doi":"10.15438/RR.5.4.126","DOIUrl":"https://doi.org/10.15438/RR.5.4.126","url":null,"abstract":"Redesigned instrumentation has become available for implantation of the Oxford Mobile Bearing Medial unicompartmental knee arthroplasty. To assess the benefit of these changes, we compared operative time of 200 Phase III and 176 Microplasty UKA done 2008-2011. An average time savings of 8.6 minutes was seen with the Microplasty design. Additionally, the standard deviation in operative times, minimum and maximum operatives were lower in knees in which Microplasty instrumentation was utilized. A 15% savings in operative time was seen with the new Microplasty instrumentation.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67681689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A simple definition of Peer Review: A process by which a scholarly work (such as a paper or a research proposal) is checked by a group of experts in the same field to make sure it meets the necessary standards before it is published or accepted.1 There has been considerable debate over the years as to the value of publications. This commentary is going to highlight my experience with publications and how the power of one scientific report of two cases has significantly impacted my life and the life of my family. My career of forty-five years in the orthopaedic field with over one hundred and eight publications, 69 citations, sixteen medical device patents, membership in nine professional medical societies prepared me for one significant effort in my personal life “the discipline and experience” to spend nearly two years researching a treatment modality for lymphocytic hypophysitis. Conclusion: This experience demonstrates how the power of one specific paper can influence and play a positive effective role in the direction, treatment and outcome in a rare and uncommon medical condition.
{"title":"The Power of One Publication","authors":"T. Mctighe","doi":"10.15438/RR.5.4.127","DOIUrl":"https://doi.org/10.15438/RR.5.4.127","url":null,"abstract":"A simple definition of Peer Review: A process by which a scholarly work (such as a paper or a research proposal) is checked by a group of experts in the same field to make sure it meets the necessary standards before it is published or accepted.1 There has been considerable debate over the years as to the value of publications. This commentary is going to highlight my experience with publications and how the power of one scientific report of two cases has significantly impacted my life and the life of my family. My career of forty-five years in the orthopaedic field with over one hundred and eight publications, 69 citations, sixteen medical device patents, membership in nine professional medical societies prepared me for one significant effort in my personal life “the discipline and experience” to spend nearly two years researching a treatment modality for lymphocytic hypophysitis. Conclusion: This experience demonstrates how the power of one specific paper can influence and play a positive effective role in the direction, treatment and outcome in a rare and uncommon medical condition.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67682244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Halim, M. Burgett-Moreno, T. Donaldson, I. Clarke
Ceramic particles are believed to be particularly abrasive due to their extreme hardness. Ceramic debris has been reported in retrieved total hip arthroplasty (THA) due to chipping and fracture of alumina components or by flaking of hydroxyapatite from implant coatings. However there appears to be no abrasion ranking of such particle behavior. The hypotheses in this study were, i) alumina particles would create large scratches in CoCr surfaces and ii) hydroxyapatite would produce very mild scratching comparable to bone-cement particles. Hydroxyapatite beads came in two types of commercial powders while the flakes were scraped from retrieved femoral stems. Alumina beads came in two commercial powders and flakes were retrieved from a fractured ceramic head. Particle morphologies were determined by SEM and CoCr surface damage by interferometry and SEM. Six 38-mm MOM were mounted inverted in a hip simulator and run with ceramic particles inserted for a 10-second test. Surface-roughness ranking after 10-second abrasion test revealed that bone cement and hydroxyapatite produced least damage to CoCr surfaces while alumina produced the most. Alumina increased surface roughness 19-fold greater than either hydroxyapatite or bone-cement particles. The alumina debris produced numerous scratches typically 20-80 µm wide with some up to 140µm wide. Surprisingly the alumina beads and flakes were pulverized within the 10-second test interval and remained adherent to the CoCr surfaces. Additionally, the hydroxyapatite although also a ceramic had no more effect on CoCr than the bone-cement debris. Use of well-characterized and commercially available alumina and hydroxyapatite powders appeared advantageous for abrasion tests. These new data indicated that such ceramic powders have merit.
{"title":"Third-body Wear Damage Produced in CoCr Surfaces by Hydroxyapatite and Alumina Ceramic Debris: A 10-cycle Metal-on-Metal Simulator Study","authors":"T. Halim, M. Burgett-Moreno, T. Donaldson, I. Clarke","doi":"10.15438/RR.5.4.129","DOIUrl":"https://doi.org/10.15438/RR.5.4.129","url":null,"abstract":"Ceramic particles are believed to be particularly abrasive due to their extreme hardness. Ceramic debris has been reported in retrieved total hip arthroplasty (THA) due to chipping and fracture of alumina components or by flaking of hydroxyapatite from implant coatings. However there appears to be no abrasion ranking of such particle behavior. The hypotheses in this study were, i) alumina particles would create large scratches in CoCr surfaces and ii) hydroxyapatite would produce very mild scratching comparable to bone-cement particles. Hydroxyapatite beads came in two types of commercial powders while the flakes were scraped from retrieved femoral stems. Alumina beads came in two commercial powders and flakes were retrieved from a fractured ceramic head. Particle morphologies were determined by SEM and CoCr surface damage by interferometry and SEM. Six 38-mm MOM were mounted inverted in a hip simulator and run with ceramic particles inserted for a 10-second test. Surface-roughness ranking after 10-second abrasion test revealed that bone cement and hydroxyapatite produced least damage to CoCr surfaces while alumina produced the most. Alumina increased surface roughness 19-fold greater than either hydroxyapatite or bone-cement particles. The alumina debris produced numerous scratches typically 20-80 µm wide with some up to 140µm wide. Surprisingly the alumina beads and flakes were pulverized within the 10-second test interval and remained adherent to the CoCr surfaces. Additionally, the hydroxyapatite although also a ceramic had no more effect on CoCr than the bone-cement debris. Use of well-characterized and commercially available alumina and hydroxyapatite powders appeared advantageous for abrasion tests. These new data indicated that such ceramic powders have merit.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67682470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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