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Stephen A. Copeland - One of the best experts on this subject based on the ideXlab platform.
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surface Replacement Arthroplasty for glenohumeral arthropathy in patients aged younger than fifty years results after a minimum ten year follow up
Journal of Shoulder and Elbow Surgery, 2015Co-Authors: Ofer Levy, Stephen A. Copeland, Oren Tsvieli, Julia Merchant, Lora Young, Alberto Trimarchi, Rupen Dattani, Ruben Abraham, Ali Narvani, Ehud AtounAbstract:Background The role of cementless surface Replacement Arthroplasty (CSRA) in young individuals is currently unclear. The aim of this study was to evaluate CSRA long-term results for glenohumeral arthritis in young patients. Methods Between 1990 and 2003, 54 CSRAs were performed on 49 patients (25 men, 24 women) aged younger than 50 years. Mean age was 38.9 years (range, 22-50 years). Three patients (4 shoulders) died over time and 8 were lost to follow-up, leaving 38 patients (42 shoulders) with a mean follow-up of 14.5 years (range, 10-25 years). There were 17 total shoulder Replacements with metal back glenoid, and 37 underwent humeral head resurfacing with microfracture of the glenoid. Results The indications were avascular necrosis, 16; rheumatoid arthritis, 20; instability arthropathy, 7; primary osteoarthritis, 5; fracture sequelae, 3; postinfection arthritis, 2; and psoriatic arthritis, 1. The mean relative Constant score increased from 11.5% to 71.8% ( P Conclusions CSRA provides good long-term symptomatic and functional results in the treatment of glenohumeral arthropathy in patients aged younger than 50 years in 81.6% of the patients. This improvement is maintained over more than 10 years after surgery, with high patient satisfaction (8.7 of 10). However, 10 shoulders (of 54) (18.5%) underwent revision Arthroplasty. Resurfacing offers a valuable tool in treating young patients with glenohumeral arthritis, providing reasonably good long-term results in 81.6% of the patients, while allowing preservation of bone stock if the need for revision arises. All the revision Arthroplasty options are preserved, including less invasive procedures.
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cementless surface Replacement Arthroplasty copeland csra for osteoarthritis of the shoulder
Journal of Shoulder and Elbow Surgery, 2004Co-Authors: Ofer Levy, Stephen A. CopelandAbstract:Abstract Clinical experience with the Copeland cementless surface Replacement Arthroplasty (CSRA) of the shoulder now spans 17 years. Between 1986 and 1997, 79 CSRAs (42 total shoulder Replacements and 37 hemiarthroplasties) were performed for primary osteoarthritis of the shoulder. Total shoulder Replacement was done in 12 men and 30 women with a mean age of 71.5 years (range, 50-87 years). HemiArthroplasty was used in 9 men and 28 women; 5 patients had bilateral hemiArthroplasty. The mean age was 73.4 years (range, 53-88 years). Thirty-nine total shoulder arthroplasties and thirty hemiarthroplasties with a follow-up of more than 2 years were available for review. The mean follow-up was 7.6 years (range, 48 months to 13 years) for total shoulder Replacement and 4.4 years (range, 24 months to 6.5 years) for hemiArthroplasty. The Constant scores improved from an age-adjusted Constant score of 33.8% (20.0 points) to 94% (61.9 points) for total shoulder Replacement and from an age-adjusted Constant score 40.0% (25.3 points) to 91% (58.1 points) for hemiArthroplasty. Active elevation improved by a mean of 59.9° to a mean of 128° for total shoulder Replacement and to a mean of 124° for hemiArthroplasty. Of the patients, 89.9% considered the shoulder to be much better or better as a result of the operation. Radiographically, one humeral implant and three glenoid implants had evidence of loosening. Four revisions were performed in the total shoulder Replacement group. No revision surgery was needed in the hemiArthroplasty group. The results of this series are at least comparable to those reported for stemmed prostheses with a comparable length of follow-up. The results of total shoulder Replacement and hemiArthroplasty in osteoarthritis of the shoulder seem to be comparable. With use of the CSRA prosthesis, several severe complications mainly concerning the humeral shaft and periprosthetic fractures can be avoided. Should the need for revision surgery or arthrodesis arise, these procedures are easily performed, as bone stock has been maintained and no loss of length has been encountered. It does seem that the humeral component does not need a stem or cement for fixation.
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copeland surface Replacement Arthroplasty of the shoulder in rheumatoid arthritis
Journal of Bone and Joint Surgery American Volume, 2004Co-Authors: Ofer Levy, Lennard Funk, Giuseppe Sforza, Stephen A. CopelandAbstract:Background: Shoulder Arthroplasty with a stemmed prosthesis is a recognized treatment for rheumatoid arthritis of the shoulder. The humeral component of the Copeland cementless surface Replacement Arthroplasty consists of a cup for surface Replacement with a short central peg for primary fixation to the bone. We hypothesized that surface Replacement may offer some advantages over stemmed prostheses. Methods: Between 1986 and 1998, seventy-five shoulders underwent surface Replacement Arthroplasty (thirty-three hemiarthroplasties and forty-two total shoulder arthroplasties) for the treatment of rheumatoid arthritis. The results of these procedures were reviewed after an average duration of follow-up of 6.5 years. Patients were assessed with use of the Constant score, a patient satisfaction score, and radiographs. Results: The average Constant score was 47.9 points (age and sex-adjusted score, 71%) in the hemiArthroplasty group and 53.4 points (age and sex-adjusted score, 76%) in the total shoulder Replacement group. The mean range of active flexion improved from 50° in the hemiArthroplasty group and 47° in the total shoulder Replacement group to 101° and 104°, respectively. Seventy-two of the seventy-five shoulders were considered by the patients to be much better or better at the time of the review. Of the sixty-eight humeral implants that were evaluated radiographically, fifty-six (82%) showed no lucencies, eleven (16%) showed localized lucencies of <1 mm in width, and one was definitely loose. Of the thirty-nine glenoid implants that were evaluated radiographically, nineteen (49%) showed no lucencies, nineteen showed localized lucencies of <1 mm, and one was definitely loose. No lucencies were observed adjacent to the hydroxyapatite-coated implants. Thirty-nine (57%) of the sixty-eight shoulders showed some degree of superior subluxation. Three patients required a major reoperation: two required a revision because of loosening of both components, and one patient with pain at the site of a hemiArthroplasty had a revision to a total shoulder Arthroplasty to provide relief. Conclusions: The indications for this surface Replacement are the same as those for the conventional stemmed prostheses, but the surface Replacement has the advantage of bone preservation as well as avoidance of the potential complications associated with a long humeral stem in rheumatoid bone. This procedure is not suitable for severely damaged joints in which the humeral head is insufficient or too soft. Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.
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cementless surface Replacement Arthroplasty of the shoulder
Journal of Bone and Joint Surgery-british Volume, 2001Co-Authors: Ofer Levy, Stephen A. CopelandAbstract:Cementless surface Replacement Arthroplasty of the shoulder is designed to replace the damaged joint surfaces and restore normal anatomy with minimal resection of bone. We have used the Copeland shoulder Arthroplasty for 14 years. Between 1986 and 2000, 285 surface Replacement arthroplasties were implanted in our unit. The prosthesis has evolved during this time, but the principle of minimal bone resection has remained the same. Between 1990 and 1994, 103 Mark-2 prostheses were inserted into 94 patients (9 bilateral). The operations were carried out for the treatment of osteoarthritis, rheumatoid arthritis, avascular necrosis, instability arthropathy, post-traumatic arthropathy and cuff arthropathy. The mean follow-up was for 6.8 years (5 to 10). The best results were achieved in primary osteoarthritis, with Constant scores of 93.7% for total shoulder Replacement and 73.5% for hemiArthroplasty. The poorest results were seen in patients with cuff arthropathy and post-traumatic arthropathy with adjusted Constant scores of 61.3% and 62.7%, respectively. Most patients (93.9%) considered their shoulder to be much better or better than before the operation. Of the 88 humeral implants available for radiological review, 61 (69.3%) showed no evidence of radiolucency, nor did 21 (35.6%) of the 59 glenoid prostheses. Three were definitely loose, and eight shoulders required revision (7.7%), two (1.9%) for primary loosening. The results of this series are comparable with those for stemmed prostheses with a similar follow-up and case mix. The cementless surface Replacement Arthroplasty diminishes the risk of complications involving the humeral shaft and periprosthetic fractures. Revision or arthrodesis can
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cementless surface Replacement Arthroplasty of the shoulder 5 to 10 year results with the copeland mark 2 prosthesis
Journal of Bone and Joint Surgery-british Volume, 2001Co-Authors: Ofer Levy, Stephen A. CopelandAbstract:Cementless surface Replacement Arthroplasty of the shoulder is designed to replace the damaged joint surfaces and restore normal anatomy with minimal resection of bone. We have used the Copeland shoulder Arthroplasty for 14 years. Between 1986 and 2000, 285 surface Replacement arthroplasties were implanted in our unit. The prosthesis has evolved during this time, but the principle of minimal bone resection has remained the same. Between 1990 and 1994, 103 Mark-2 prostheses were inserted into 94 patients (9 bilateral). The operations were carried out for the treatment of osteoarthritis, rheumatoid arthritis, avascular necrosis, instability arthropathy, post-traumatic arthropathy and cuff arthropathy. The mean follow-up was for 6.8 years (5 to 10). The best results were achieved in primary osteoarthritis, with Constant scores of 93.7% for total shoulder Replacement and 73.5% for hemiArthroplasty. The poorest results were seen in patients with cuff arthropathy and post-traumatic arthropathy with adjusted Constant scores of 61.3% and 62.7%, respectively. Most patients (93.9%) considered their shoulder to be much better or better than before the operation. Of the 88 humeral implants available for radiological review, 61 (69.3%) showed no evidence of radiolucency, nor did 21 (35.6%) of the 59 glenoid prostheses. Three were definitely loose, and eight shoulders required revision (7.7%), two (1.9%) for primary loosening. The results of this series are comparable with those for stemmed prostheses with a similar follow-up and case mix. The cementless surface Replacement Arthroplasty diminishes the risk of complications involving the humeral shaft and periprosthetic fractures. Revision or arthrodesis can be undertaken easily since the bone stock has been maintained with no loss of length.
Paul C Mcafee - One of the best experts on this subject based on the ideXlab platform.
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adjacent level intradiscal pressure and segmental kinematics following a cervical total disc Arthroplasty an in vitro human cadaveric model
Spine, 2005Co-Authors: Anton E Dmitriev, Bryan W Cunningham, Nianbin Hu, Gregory Sell, Franco Vigna, Paul C McafeeAbstract:Study Design. In vitro investigation of cervical adjacent level intradiscal pressures (IDPs) following a total disc Replacement Arthroplasty. Objectives. The current in vitro study was undertaken to compare adjacent level IDPs and operative level kinematics following a cervical Arthroplasty versus an arthrodesis procedure. Summary of Background Data. Clinical data indicate the incidence of symptomatic transition syndrome to be as high as 3% annually following a cervical interbody arthrodesis. Recent developments in the motion preservation technology should, in theory, minimize transition syndrome at the adjacent levels. Methods. A total of 10 human cadaveric cervical spines were used in this investigation. Following intact analysis, all specimens were sequentially reconstructed at C5–C6 with 1) total disc Replacement (TDR), 2) allograft dowel, and 3) allograft dowel + anterior cervical plate. Testing was performed in displacement control under axial rotation, flexion/extension, and lateral bending loading modes. IDPs were recorded at C4–C5 and C6–C7 whereas peak range of motion (ROM) and NZ were monitored at C5–C6 level. Results. Similar IDPs were recorded between the intact condition and a TDR reconstruction at both adjacent levels under all loading modes (P > 0.05). However, the C4–C5 IDP values produced under flexion/extension testing for both arthrodesis treatments were significantly higher than the means obtained for the intact and disc Replacement groups (P 0.05). Conclusion. This is a first study to document that a cervical disc Replacement Arthroplasty procedure maintains adjacent level IDPs and reconstruction level kinematics near the preoperative values. Consequently, total disc Replacement may provide an alternative to conventional surgical management of cervical discogenic pathology decreasing the incidence of symptomatic transition syndrome.
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general principles of total disc Replacement Arthroplasty seventeen cases in a nonhuman primate model
Spine, 2003Co-Authors: Bryan W Cunningham, Anton E Dmitriev, Paul C McafeeAbstract:STUDY DESIGN: To investigate the biomechanical, histochemical, and biologic ingrowth characteristics of two different lumbar disc prostheses-AcroFlex (DePuy-AcroMed) and the SB Charite (DePuy-AcroMed)-for total disc Replacement Arthroplasty. METHODS: A total of 17 mature baboons (n = 17, Papio cynocephalus) underwent L5-L6 total disc Replacement procedures. The AcroFlex device (n = 10 levels) consisted of sintered titanium beaded ingrowth surfaces, bound together by a hexene-based polyolefin rubber core. The SB Charite (n = 7 levels) device prosthetic vertebral end plates were cobalt chrome, covered by two layers of thin titanium with an electrochemically bonded hydroxyapatite coating and an ultra-high molecular weight polyethylene core. RESULTS: Following 6-month survival periods, the range of motion of the SB Charite and intact nonoperative controls under axial compression, flexion-extension, and lateral bending showed no statistical difference (P > 0.05). However, both exhibited greater range of motion compared to the AcroFlex treatments (P < 0.05). Plain film radiographic analysis showed no lucencies or loosening of any metallic prosthetic vertebral endplate. Gross histopathologic analysis of the AcroFlex and SB Charite prosthesis demonstrated excellent ingrowth at the level of the implant-bone interface, without evidence of fibrous tissue or synovium. Histochemical assays showed no local or systemic accumulation of particulate wear debris (titanium, ultra-high molecular weight polyethylene, or cobalt chrome) nor cytokines (TNF-alpha, PGE2, IL-1, IL-2, or IL-6). Porous ingrowth calculations showed the mean ingrowth (linear apposition) ranging from 47.9% +/- 9.12 for the SB Charite device and 54.59% +/- 13.24 for the AcroFlex device. CONCLUSIONS: The porous ingrowth, percentage pore ingrowth coverage at the bone-metal interface was more favorable for total disc Replacement compared to that reported for cementless total joint components in the appendicular skeleton (range 10-30%). The reason for the improved degree of porous ingrowth in total disc Replacement prostheses is probably due to ligamentotaxis causing sustained compression across the metal-bone interface. This project serves as the first comprehensive in vivo investigation comparing two different types of unconstrained disc prostheses with alternate in-growth surfaces and establishes an excellent research model in the evaluation of lumbar total disc Replacement Arthroplasty.
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biomechanical evaluation of total disc Replacement Arthroplasty an in vitro human cadaveric model
Spine, 2003Co-Authors: Bryan W Cunningham, Anton E Dmitriev, Jeffrey D Gordon, Paul C McafeeAbstract:STUDY DESIGN This in vitro biomechanical study was undertaken to quantify the multidirectional intervertebral kinematics following total disc Replacement Arthroplasty compared to conventional stabilization techniques. OBJECTIVE Using an in vitro human cadaveric model, the primary objective was to compare the multidirectional flexibility properties and map the center of intervertebral rotation of total disc Arthroplasty versus conventional threaded fusion cages and cages augmented with transpedicular fixation for single-level spinal instrumentation. SUMMARY OF BACKGROUND DATA The utilization of motion-preserving implants versus instrumentation systems, which stabilize the operative segments, necessitates improved understanding of their comparative biomechanical properties. METHODS A total of eight human cadaveric lumbosacral spines (L2 to sacrum) were utilized in this investigation and biomechanically evaluated under the following L4-L5 reconstruction conditions: 1) intact spine; 2) SB Charite disc prosthesis; 3) BAK cages; and 4) BAK cages + ISOLA pedicle screw/rod fixation (anteroposterior). The superior (L3-L4) and inferior (L5-S1) intervertebral levels remained uninstrumented to quantify adjacent level properties. Multidirectional flexibility included pure, unconstrained moments (+/-8 Nm) in axial rotation, flexion-extension, and lateral bending, with quantification of the operative and adjacent level range of motion and neutral zone, which were normalized to the intact spine condition. RESULTS The SB Charite prosthesis indicated an average percentage increase in axial rotation range of motion by 44% compared to the intact condition (P 0.05), whereas the BAK and anteroposterior stabilization groups resulted in significant decreases in range of motion (BAK = 57%, anteroposterior = 93%) (P < 0.05) when compared to the intact and SB Charite conditions. Based on flexion-extension radiographs, the intervertebral centers of rotation were in the posterior one-third of the operative intervertebral disc only for the SB Charite reconstruction and intact spine condition, with definitive evidence of physiologic intervertebral translation (intact 2.06 +/- 77 mm; SB III = 1.9 +/- 0.98 mm). CONCLUSIONS Total disc Arthroplasty serves as the next frontier in the surgical management of discogenic spinal pathology. The SB Charite restored motion to the level of the intact segment in flexion-extension and lateral bending and increased motion in axial rotation. The anterior annular resection necessary for device implantation and unconstrained design of the prosthesis account for this change in rotation. The normal lumbar flexion-extension axis of rotation is an ellipse rather than a single point. Only disc Replacement rather than pedicle instrumentation or BAK interbody instrumentation preserves the kinematic properties and normal mapping of segmental motion at the operative and adjacent intervertebral disc levels.
Ofer Levy - One of the best experts on this subject based on the ideXlab platform.
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surface Replacement Arthroplasty for glenohumeral arthropathy in patients aged younger than fifty years results after a minimum ten year follow up
Journal of Shoulder and Elbow Surgery, 2015Co-Authors: Ofer Levy, Stephen A. Copeland, Oren Tsvieli, Julia Merchant, Lora Young, Alberto Trimarchi, Rupen Dattani, Ruben Abraham, Ali Narvani, Ehud AtounAbstract:Background The role of cementless surface Replacement Arthroplasty (CSRA) in young individuals is currently unclear. The aim of this study was to evaluate CSRA long-term results for glenohumeral arthritis in young patients. Methods Between 1990 and 2003, 54 CSRAs were performed on 49 patients (25 men, 24 women) aged younger than 50 years. Mean age was 38.9 years (range, 22-50 years). Three patients (4 shoulders) died over time and 8 were lost to follow-up, leaving 38 patients (42 shoulders) with a mean follow-up of 14.5 years (range, 10-25 years). There were 17 total shoulder Replacements with metal back glenoid, and 37 underwent humeral head resurfacing with microfracture of the glenoid. Results The indications were avascular necrosis, 16; rheumatoid arthritis, 20; instability arthropathy, 7; primary osteoarthritis, 5; fracture sequelae, 3; postinfection arthritis, 2; and psoriatic arthritis, 1. The mean relative Constant score increased from 11.5% to 71.8% ( P Conclusions CSRA provides good long-term symptomatic and functional results in the treatment of glenohumeral arthropathy in patients aged younger than 50 years in 81.6% of the patients. This improvement is maintained over more than 10 years after surgery, with high patient satisfaction (8.7 of 10). However, 10 shoulders (of 54) (18.5%) underwent revision Arthroplasty. Resurfacing offers a valuable tool in treating young patients with glenohumeral arthritis, providing reasonably good long-term results in 81.6% of the patients, while allowing preservation of bone stock if the need for revision arises. All the revision Arthroplasty options are preserved, including less invasive procedures.
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copeland surface Replacement of the shoulder results of an hydroxyapatite coated cementless implant in patients over 80 years of age
Journal of Bone and Joint Surgery-british Volume, 2007Co-Authors: Hannan Mullett, Ofer Levy, Ruben Abraham, D Raj, Tirtza Even, S CopelandAbstract:We describe the results of Copeland surface Replacement shoulder Arthroplasty using the mark III prosthesis in patients over 80 years of age. End-stage arthritis of the shoulder is a source of significant pain and debilitating functional loss in the elderly. An Arthroplasty offers good relief of pain and may allow the patient to maintain independence. The risk-benefit ratio of shoulder Replacement may be felt to be too high in an elderly age group, but there is no published evidence to support this theory. We have assessed whether the procedure was as reliable and safe as previously seen in a younger cohort of patients. Between 1993 and 2003, 213 Copeland surface Replacement Arthroplasty procedures were performed in our unit, of which 29 (13.6%) were undertaken in patients over the age of 80. This group of patients was followed up for a mean of 4.5 years (2.1 to 9.3). Their mean age was 84.3 years (81 to 93), the mean operating time was 40 minutes (30 to 45) and the mean in-patient stay was five days (2 to 21). There were no peri-operative deaths or significant complications. The mean Constant score adjusted for age and gender, improved from 15.1% to 77%. Copeland surface Replacement shoulder Arthroplasty may be performed with minimal morbidity and rapid rehabilitation in the elderly.
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cementless surface Replacement Arthroplasty copeland csra for osteoarthritis of the shoulder
Journal of Shoulder and Elbow Surgery, 2004Co-Authors: Ofer Levy, Stephen A. CopelandAbstract:Abstract Clinical experience with the Copeland cementless surface Replacement Arthroplasty (CSRA) of the shoulder now spans 17 years. Between 1986 and 1997, 79 CSRAs (42 total shoulder Replacements and 37 hemiarthroplasties) were performed for primary osteoarthritis of the shoulder. Total shoulder Replacement was done in 12 men and 30 women with a mean age of 71.5 years (range, 50-87 years). HemiArthroplasty was used in 9 men and 28 women; 5 patients had bilateral hemiArthroplasty. The mean age was 73.4 years (range, 53-88 years). Thirty-nine total shoulder arthroplasties and thirty hemiarthroplasties with a follow-up of more than 2 years were available for review. The mean follow-up was 7.6 years (range, 48 months to 13 years) for total shoulder Replacement and 4.4 years (range, 24 months to 6.5 years) for hemiArthroplasty. The Constant scores improved from an age-adjusted Constant score of 33.8% (20.0 points) to 94% (61.9 points) for total shoulder Replacement and from an age-adjusted Constant score 40.0% (25.3 points) to 91% (58.1 points) for hemiArthroplasty. Active elevation improved by a mean of 59.9° to a mean of 128° for total shoulder Replacement and to a mean of 124° for hemiArthroplasty. Of the patients, 89.9% considered the shoulder to be much better or better as a result of the operation. Radiographically, one humeral implant and three glenoid implants had evidence of loosening. Four revisions were performed in the total shoulder Replacement group. No revision surgery was needed in the hemiArthroplasty group. The results of this series are at least comparable to those reported for stemmed prostheses with a comparable length of follow-up. The results of total shoulder Replacement and hemiArthroplasty in osteoarthritis of the shoulder seem to be comparable. With use of the CSRA prosthesis, several severe complications mainly concerning the humeral shaft and periprosthetic fractures can be avoided. Should the need for revision surgery or arthrodesis arise, these procedures are easily performed, as bone stock has been maintained and no loss of length has been encountered. It does seem that the humeral component does not need a stem or cement for fixation.
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copeland surface Replacement Arthroplasty of the shoulder in rheumatoid arthritis
Journal of Bone and Joint Surgery American Volume, 2004Co-Authors: Ofer Levy, Lennard Funk, Giuseppe Sforza, Stephen A. CopelandAbstract:Background: Shoulder Arthroplasty with a stemmed prosthesis is a recognized treatment for rheumatoid arthritis of the shoulder. The humeral component of the Copeland cementless surface Replacement Arthroplasty consists of a cup for surface Replacement with a short central peg for primary fixation to the bone. We hypothesized that surface Replacement may offer some advantages over stemmed prostheses. Methods: Between 1986 and 1998, seventy-five shoulders underwent surface Replacement Arthroplasty (thirty-three hemiarthroplasties and forty-two total shoulder arthroplasties) for the treatment of rheumatoid arthritis. The results of these procedures were reviewed after an average duration of follow-up of 6.5 years. Patients were assessed with use of the Constant score, a patient satisfaction score, and radiographs. Results: The average Constant score was 47.9 points (age and sex-adjusted score, 71%) in the hemiArthroplasty group and 53.4 points (age and sex-adjusted score, 76%) in the total shoulder Replacement group. The mean range of active flexion improved from 50° in the hemiArthroplasty group and 47° in the total shoulder Replacement group to 101° and 104°, respectively. Seventy-two of the seventy-five shoulders were considered by the patients to be much better or better at the time of the review. Of the sixty-eight humeral implants that were evaluated radiographically, fifty-six (82%) showed no lucencies, eleven (16%) showed localized lucencies of <1 mm in width, and one was definitely loose. Of the thirty-nine glenoid implants that were evaluated radiographically, nineteen (49%) showed no lucencies, nineteen showed localized lucencies of <1 mm, and one was definitely loose. No lucencies were observed adjacent to the hydroxyapatite-coated implants. Thirty-nine (57%) of the sixty-eight shoulders showed some degree of superior subluxation. Three patients required a major reoperation: two required a revision because of loosening of both components, and one patient with pain at the site of a hemiArthroplasty had a revision to a total shoulder Arthroplasty to provide relief. Conclusions: The indications for this surface Replacement are the same as those for the conventional stemmed prostheses, but the surface Replacement has the advantage of bone preservation as well as avoidance of the potential complications associated with a long humeral stem in rheumatoid bone. This procedure is not suitable for severely damaged joints in which the humeral head is insufficient or too soft. Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.
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cementless surface Replacement Arthroplasty of the shoulder
Journal of Bone and Joint Surgery-british Volume, 2001Co-Authors: Ofer Levy, Stephen A. CopelandAbstract:Cementless surface Replacement Arthroplasty of the shoulder is designed to replace the damaged joint surfaces and restore normal anatomy with minimal resection of bone. We have used the Copeland shoulder Arthroplasty for 14 years. Between 1986 and 2000, 285 surface Replacement arthroplasties were implanted in our unit. The prosthesis has evolved during this time, but the principle of minimal bone resection has remained the same. Between 1990 and 1994, 103 Mark-2 prostheses were inserted into 94 patients (9 bilateral). The operations were carried out for the treatment of osteoarthritis, rheumatoid arthritis, avascular necrosis, instability arthropathy, post-traumatic arthropathy and cuff arthropathy. The mean follow-up was for 6.8 years (5 to 10). The best results were achieved in primary osteoarthritis, with Constant scores of 93.7% for total shoulder Replacement and 73.5% for hemiArthroplasty. The poorest results were seen in patients with cuff arthropathy and post-traumatic arthropathy with adjusted Constant scores of 61.3% and 62.7%, respectively. Most patients (93.9%) considered their shoulder to be much better or better than before the operation. Of the 88 humeral implants available for radiological review, 61 (69.3%) showed no evidence of radiolucency, nor did 21 (35.6%) of the 59 glenoid prostheses. Three were definitely loose, and eight shoulders required revision (7.7%), two (1.9%) for primary loosening. The results of this series are comparable with those for stemmed prostheses with a similar follow-up and case mix. The cementless surface Replacement Arthroplasty diminishes the risk of complications involving the humeral shaft and periprosthetic fractures. Revision or arthrodesis can
Bryan W Cunningham - One of the best experts on this subject based on the ideXlab platform.
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adjacent level intradiscal pressure and segmental kinematics following a cervical total disc Arthroplasty an in vitro human cadaveric model
Spine, 2005Co-Authors: Anton E Dmitriev, Bryan W Cunningham, Nianbin Hu, Gregory Sell, Franco Vigna, Paul C McafeeAbstract:Study Design. In vitro investigation of cervical adjacent level intradiscal pressures (IDPs) following a total disc Replacement Arthroplasty. Objectives. The current in vitro study was undertaken to compare adjacent level IDPs and operative level kinematics following a cervical Arthroplasty versus an arthrodesis procedure. Summary of Background Data. Clinical data indicate the incidence of symptomatic transition syndrome to be as high as 3% annually following a cervical interbody arthrodesis. Recent developments in the motion preservation technology should, in theory, minimize transition syndrome at the adjacent levels. Methods. A total of 10 human cadaveric cervical spines were used in this investigation. Following intact analysis, all specimens were sequentially reconstructed at C5–C6 with 1) total disc Replacement (TDR), 2) allograft dowel, and 3) allograft dowel + anterior cervical plate. Testing was performed in displacement control under axial rotation, flexion/extension, and lateral bending loading modes. IDPs were recorded at C4–C5 and C6–C7 whereas peak range of motion (ROM) and NZ were monitored at C5–C6 level. Results. Similar IDPs were recorded between the intact condition and a TDR reconstruction at both adjacent levels under all loading modes (P > 0.05). However, the C4–C5 IDP values produced under flexion/extension testing for both arthrodesis treatments were significantly higher than the means obtained for the intact and disc Replacement groups (P 0.05). Conclusion. This is a first study to document that a cervical disc Replacement Arthroplasty procedure maintains adjacent level IDPs and reconstruction level kinematics near the preoperative values. Consequently, total disc Replacement may provide an alternative to conventional surgical management of cervical discogenic pathology decreasing the incidence of symptomatic transition syndrome.
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general principles of total disc Replacement Arthroplasty seventeen cases in a nonhuman primate model
Spine, 2003Co-Authors: Bryan W Cunningham, Anton E Dmitriev, Paul C McafeeAbstract:STUDY DESIGN: To investigate the biomechanical, histochemical, and biologic ingrowth characteristics of two different lumbar disc prostheses-AcroFlex (DePuy-AcroMed) and the SB Charite (DePuy-AcroMed)-for total disc Replacement Arthroplasty. METHODS: A total of 17 mature baboons (n = 17, Papio cynocephalus) underwent L5-L6 total disc Replacement procedures. The AcroFlex device (n = 10 levels) consisted of sintered titanium beaded ingrowth surfaces, bound together by a hexene-based polyolefin rubber core. The SB Charite (n = 7 levels) device prosthetic vertebral end plates were cobalt chrome, covered by two layers of thin titanium with an electrochemically bonded hydroxyapatite coating and an ultra-high molecular weight polyethylene core. RESULTS: Following 6-month survival periods, the range of motion of the SB Charite and intact nonoperative controls under axial compression, flexion-extension, and lateral bending showed no statistical difference (P > 0.05). However, both exhibited greater range of motion compared to the AcroFlex treatments (P < 0.05). Plain film radiographic analysis showed no lucencies or loosening of any metallic prosthetic vertebral endplate. Gross histopathologic analysis of the AcroFlex and SB Charite prosthesis demonstrated excellent ingrowth at the level of the implant-bone interface, without evidence of fibrous tissue or synovium. Histochemical assays showed no local or systemic accumulation of particulate wear debris (titanium, ultra-high molecular weight polyethylene, or cobalt chrome) nor cytokines (TNF-alpha, PGE2, IL-1, IL-2, or IL-6). Porous ingrowth calculations showed the mean ingrowth (linear apposition) ranging from 47.9% +/- 9.12 for the SB Charite device and 54.59% +/- 13.24 for the AcroFlex device. CONCLUSIONS: The porous ingrowth, percentage pore ingrowth coverage at the bone-metal interface was more favorable for total disc Replacement compared to that reported for cementless total joint components in the appendicular skeleton (range 10-30%). The reason for the improved degree of porous ingrowth in total disc Replacement prostheses is probably due to ligamentotaxis causing sustained compression across the metal-bone interface. This project serves as the first comprehensive in vivo investigation comparing two different types of unconstrained disc prostheses with alternate in-growth surfaces and establishes an excellent research model in the evaluation of lumbar total disc Replacement Arthroplasty.
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biomechanical evaluation of total disc Replacement Arthroplasty an in vitro human cadaveric model
Spine, 2003Co-Authors: Bryan W Cunningham, Anton E Dmitriev, Jeffrey D Gordon, Paul C McafeeAbstract:STUDY DESIGN This in vitro biomechanical study was undertaken to quantify the multidirectional intervertebral kinematics following total disc Replacement Arthroplasty compared to conventional stabilization techniques. OBJECTIVE Using an in vitro human cadaveric model, the primary objective was to compare the multidirectional flexibility properties and map the center of intervertebral rotation of total disc Arthroplasty versus conventional threaded fusion cages and cages augmented with transpedicular fixation for single-level spinal instrumentation. SUMMARY OF BACKGROUND DATA The utilization of motion-preserving implants versus instrumentation systems, which stabilize the operative segments, necessitates improved understanding of their comparative biomechanical properties. METHODS A total of eight human cadaveric lumbosacral spines (L2 to sacrum) were utilized in this investigation and biomechanically evaluated under the following L4-L5 reconstruction conditions: 1) intact spine; 2) SB Charite disc prosthesis; 3) BAK cages; and 4) BAK cages + ISOLA pedicle screw/rod fixation (anteroposterior). The superior (L3-L4) and inferior (L5-S1) intervertebral levels remained uninstrumented to quantify adjacent level properties. Multidirectional flexibility included pure, unconstrained moments (+/-8 Nm) in axial rotation, flexion-extension, and lateral bending, with quantification of the operative and adjacent level range of motion and neutral zone, which were normalized to the intact spine condition. RESULTS The SB Charite prosthesis indicated an average percentage increase in axial rotation range of motion by 44% compared to the intact condition (P 0.05), whereas the BAK and anteroposterior stabilization groups resulted in significant decreases in range of motion (BAK = 57%, anteroposterior = 93%) (P < 0.05) when compared to the intact and SB Charite conditions. Based on flexion-extension radiographs, the intervertebral centers of rotation were in the posterior one-third of the operative intervertebral disc only for the SB Charite reconstruction and intact spine condition, with definitive evidence of physiologic intervertebral translation (intact 2.06 +/- 77 mm; SB III = 1.9 +/- 0.98 mm). CONCLUSIONS Total disc Arthroplasty serves as the next frontier in the surgical management of discogenic spinal pathology. The SB Charite restored motion to the level of the intact segment in flexion-extension and lateral bending and increased motion in axial rotation. The anterior annular resection necessary for device implantation and unconstrained design of the prosthesis account for this change in rotation. The normal lumbar flexion-extension axis of rotation is an ellipse rather than a single point. Only disc Replacement rather than pedicle instrumentation or BAK interbody instrumentation preserves the kinematic properties and normal mapping of segmental motion at the operative and adjacent intervertebral disc levels.
Martin Lavigne - One of the best experts on this subject based on the ideXlab platform.
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gait patterns after total hip Arthroplasty and surface Replacement Arthroplasty
Archives of Physical Medicine and Rehabilitation, 2009Co-Authors: Julie Nantel, Pascal-andré Vendittoli, Martin Lavigne, Nicolas Termoz, Francois PrinceAbstract:Abstract Nantel J, Termoz N, Vendittoli P-A, Lavigne M, Prince F. Gait patterns after total hip Arthroplasty and surface Replacement Arthroplasty. Objective To compare gait patterns in patients with total hip Arthroplasty (THA) and surface hip Arthroplasty. Design Observational study. Setting Outpatient biomechanical laboratory. Participants Two groups of 10 surface hip Arthroplasty and THA patients and 10 control subjects participated in the study (N=30). The patients were volunteers recruited from a larger randomized study. Interventions Not applicable. Main Outcomes Measures Gait patterns, hip abductor muscle strength, clinical outcomes, and radiographic analyses were compared between groups. Results In the sagittal plane, the THA group showed a larger flexor moment and larger mechanical work in H2S and K3S power bursts compared with surface hip Arthroplasty and control subjects. In the frontal plane, both THA and surface hip Arthroplasty patients had smaller hip abductor muscles energy generation (H3F) than the control group. No difference was found for the hip abductor muscles strength. Conclusions In the THA group, the larger energy absorption in H2S and K3S would be a cost-effective mechanical adaptation to increase stability. The surface hip Arthroplasty characteristics could allow the return to a more normative gait pattern compared with THA. The modification in the frontal plane in surface hip Arthroplasty and THA would be related to the hip abductor muscles strength.
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heterotopic ossification after surface Replacement Arthroplasty and total hip Arthroplasty a randomized study
Journal of Arthroplasty, 2009Co-Authors: Krishna Reddi Boddu Siva Rama, Rene Borgmann, Muthu Ganapathi, Pascal-andré Vendittoli, Martin LavigneAbstract:Abstract With a randomized clinical trial, we compared the incidence and severity of heterotopic ossification in cohorts of patients who have undergone either surface Replacement Arthroplasty or total hip Arthroplasty at a minimum follow-up of 1 year. Surface Replacement Arthroplasty group had a significantly higher rate of severe heterotopic ossification (Brooker grades 3-4) than the total hip Arthroplasty group, 12.6% (13/103) vs 2.1% (2/97) respectively ( P = .02). Grade 4 heterotopic ossification was observed (4.9%, 5/103) exclusively in the surface Replacement Arthroplasty group. Patients with severe heterotopic ossification had significantly inferior functional outcome scores. Surgeons offering surface Replacement must be aware of this risk and use meticulous surgical technique and consider routine prophylaxis against heterotopic ossification.
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postural balance during quiet standing in patients with total hip Arthroplasty and surface Replacement Arthroplasty
Clinical Biomechanics, 2008Co-Authors: Julie Nantel, Pascal-andré Vendittoli, Martin Lavigne, Nicolas Termoz, Hugo Centomo, Francois PrinceAbstract:Background Primary total hip Arthroplasty leads to better functional capacities but a general weakness of abductor muscles often persists. A larger head component may improve the postural balance in the medial–lateral direction. The aims of this study are (1) to compare postural stability in patients after total hip and surface Replacement arthroplasties and (2) to evaluate the effect of the biomechanical reconstruction on postural stability. Methods Six months post-surgery, three groups of ten subjects (total hip and surface Replacement arthroplasties and control) performed quiet standing tasks in both dual and one leg stance and a hip abductor muscles strength test. The root-mean-square amplitude of centre of pressure and centre of mass displacement in the anterior–posterior and medial–lateral directions were calculated for dual stance task. Findings Statistical analyses showed greater centre of pressure and centre of mass displacement amplitude in the medial–lateral direction during the dual stance for the total hip Arthroplasty compared to the surface Replacement and control subjects (P < 0.05). All control subjects completed the one leg stance compared to nine in the surface Replacement and five in the total hip Arthroplasty group. No statistical difference was found between the groups in the hip abductor muscles strength. Interpretation The better anatomical preservation, absence of femoral stem and the larger bearing component could account for the return to better postural stability in surface Replacement patients in comparison to total hip patients. Further studies are needed to determine the impact of each of these factors on the postural balance.
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chromium and cobalt ion release following the durom high carbon content forged metal on metal surface Replacement of the hip
Journal of Bone and Joint Surgery-british Volume, 2007Co-Authors: Pascal-andré Vendittoli, S Mottard, A G Roy, C Dupont, Martin LavigneAbstract:We evaluated the concentrations of chromium and cobalt ions in blood after metal-on-metal surface Replacement Arthroplasty using a wrought-forged, high carbon content chromium-cobalt alloy implant in 64 patients. At one year, mean whole blood ion levels were 1.61 microg/L (0.4 to 5.5) for chromium and 0.67 microg/L (0.23 to 2.09) for cobalt. The pre-operative ion levels, component size, female gender and the inclination of the acetabular component were inversely proportional to the values of chromium and/or cobalt ions at one year postoperatively. Other factors, such as age and level of activity, did not correlate with the levels of metal ions. We found that the levels of the ions in the serum were 1.39 and 1.37 times higher for chromium and cobalt respectively than those in the whole blood. The levels of metal ions obtained may be specific to the hip resurfacing implant and reflect its manufacturing process.
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a prospective randomized clinical trial comparing metal on metal total hip Arthroplasty and metal on metal total hip resurfacing in patients less than 65 years old
Hip International, 2006Co-Authors: Pascal-andré Vendittoli, Martin Lavigne, Alain Roy, Daniel LusignanAbstract:The purpose of this prospective randomised study is to compare the early clinical results of the metal-on-metal hip resurfacing to metal-on-metal THA. Two hundred and ten hips were randomised between August 2003 and January 2006 (191 subjects). One hundred and two hips were implanted with an uncemented titanium tapered stem, and an uncemented titanium acetabular component and 28 mm metal-on-metal bearing (THA group) and 103 hips received a hybrid metal-on-metal surface Replacement Arthroplasty (SRA group). No significant difference was found with the WOMAC or Merle dAubign-Postel scales. However, a significantly higher activity level was found in the SRA group (UCLA score 6.3 versus 7.1, p= 0.037) and a greater percentage of the SRA patients returned to heavy or moderate activities at one - year postoperatively (72% versus 39%, p=0.007). No patient in either group presented with thigh pain one year after surgery. Both techniques present similar complication rates (0.15). This study supports the theory of better functional recovery in the short-term favouring the SRA when compared to THA. The clear benefit of surface Replacement Arthroplasty over THA is proximal femoral bone preservation. However, the long term survivorship of the SRA will determine the real value of the theoretical advantage.
