Abstract：
BACKGROUND:Low-cost indigenous megaprostheses used in the developing world are prone to mechanical failure but the frequency and causes are not well established. QUESTIONS/PURPOSES:We retrospectively analyzed the causes of failure, particularly design, and suggest changes to reduce the breakage. We also report our experience with revision surgery. METHODS:We identified 28 breakages in 266 megaprosthetic knee arthroplasties performed between January 2000 and December 2006. Twenty-six breakages were revised to another prosthesis. The complications were studied and the function was evaluated. Prostheses were studied for failure by the computer-aided design program SolidWorks(®) and Hyperworks(®) for finite element analysis (FEA). Design improvements were performed based on these results. RESULTS:In 21 cases, the failure occurred at the stem-collar junction, the point of maximum stress predicted by FEA. Stainless steel implants were prone to failure. There was one early and one late infection. Three patients died of metastatic disease. The most difficult surgical step involved the removal of the well-cemented broken stem from the intramedullary canal. Musculoskeletal Tumor Society scores varied from 27 to 29 after revision. FEA revealed stress could be reduced by filleting the stem-collar junction and by two-piece stems. CONCLUSIONS:Revisions of broken total knee megaprostheses, though technically difficult, have allowed patients reasonable function. We recommend design analysis for custom prostheses to point to areas of weakness. Breakages can be reduced by using titanium stems and filleting the junction or by having two-piece inserted stems. Incorporating these changes has reduced the failures in our experience.
journal_name
Clin Orthop Relat Resjournal_title
Clinical orthopaedics and related researchauthors
Agarwal M,Gulia A,Ravi B,Ghyar R,Puri Adoi
10.1007/s11999-010-1409-2subject
Has Abstractpub_date
2010-11-01 00:00:00pages
2904-13issue
11eissn
0009-921Xissn
1528-1132journal_volume
468pub_type
杂志文章abstract：:Twenty two patients (24 shoulders) who had undergone hemodialysis for a mean of 13.4 years, and who had reported chronic shoulder pain for > 6 months, were examined by magnetic resonance imaging (MRI), including T1 and T2 echo gradient images in the frontal plane and T1 images after gadolinium. An increase in thicknes...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1994-07-01 00:00:00
abstract：BACKGROUND:Musculoskeletal injury is the most common reason that soldiers are medically not ready to deploy. Understanding intrinsic risk factors that may place an elite soldier at risk of musculoskeletal injury may be beneficial in preventing musculoskeletal injury and maintaining operational military readiness. Findi...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1007/s11999-015-4342-6
更新日期：2015-09-01 00:00:00
abstract：:Habilitation of the upper extremity limb-deficient child is enhanced when the treatment program is based on normal growth and development guidelines. Specific developmental tasks have been identified as key indicators of a child's readiness to benefit from prosthetic fitting, activation of major components, use traini...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1980-05-01 00:00:00
abstract：:A recently designed Charcot Restraint Orthotic Walker (CROW) was used in the treatment of 18 patients with diabetic neuroarthropathy involving the foot and ankle. Eight of these patients had no surgery before the use of the CROW. In ten patients, the device was used for prolonged immobilization after surgery for compl...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1993-11-01 00:00:00
abstract：BACKGROUND:Decision-making regarding nonoperative versus operative treatment of patients with thoracolumbar burst fractures in the absence of neurologic deficits is controversial. Lack of evidence-based practice may result in patients being treated inappropriately and being exposed to unnecessary adverse consequences. ...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章,meta分析,评审
doi：10.1007/s11999-011-2157-7
更新日期：2012-02-01 00:00:00
abstract：BACKGROUND:Rotational malalignment of total knee arthroplasty (TKA) has been correlated with patellofemoral maltracking, knee instability, and stiffness. CT is the most accurate method to assess rotational alignment of prosthetic components after TKA, but inter- and intraobserver reliability of CT scans for this use ha...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1007/s11999-013-3111-7
更新日期：2014-01-01 00:00:00
abstract：:Intraoperative femoral fracture is a well-recognized technical complication of cementless total hip arthroplasty. This study was designed to establish an in vitro model for initiation and propagation of fractures of the proximal femur in cementless THA and to assess the effect of fracture fixation in the form of cercl...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1991-11-01 00:00:00
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journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/01.blo.0000092995.90435.ee
更新日期：2003-11-01 00:00:00
abstract：BACKGROUND:Biocomposite suture anchors containing osteoconductive materials have gained popularity in rotator cuff repairs. However, little is known about the influence of the addition of osteoconductive materials on implant resorption, bone reaction, tendon healing, and clinical outcomes scores. QUESTIONS/PURPOSES:(1...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/CORR.0000000000000665
更新日期：2019-06-01 00:00:00
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journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/01.blo.0000164027.06880.3a
更新日期：2005-08-01 00:00:00
abstract：:This Classic Article is a reprint of the original work by T. W. Huntington, Case of bone transference. Use of a segment of fibula to supply a defect in the tibia. An accompanying biographical sketch of T. W. Huntington is available at DOI 10.1007/s11999-012-2495-0 . The classic article is 1905 and is reprinted courtes...
journal_title：Clinical orthopaedics and related research
pub_type： 传,古典文章,历史文章,杂志文章
doi：10.1007/s11999-012-2496-z
更新日期：2012-10-01 00:00:00
abstract：:Twenty consecutive cases of infected total knee replacements surgically treated between 1990 and 1993 in which complete clinical and financial data were available were reviewed to determine the resources required of the hospital and the surgeon. These results were compared with a similar analysis of a stratified, unse...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/00003086-199610000-00019
更新日期：1996-10-01 00:00:00
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journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/00003086-197505000-00012
更新日期：1975-05-01 00:00:00
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journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1007/s11999-013-2821-1
更新日期：2013-06-01 00:00:00
abstract：:Eleven patients with Legg-Calvé-Perthes disease (LCP) were examined ultrasonographically for their femoral head deformity. The outline of the cartilaginous femoral head was well demonstrated, and the image obtained corresponded to that observed by arthrography. Using ultrasonography, a simple method was developed to d...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1987-07-01 00:00:00
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journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章,评审
doi：10.1097/00003086-200110000-00008
更新日期：2001-10-01 00:00:00
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journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1992-12-01 00:00:00
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journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章,多中心研究
doi：10.1007/s11999-008-0285-5
更新日期：2008-11-01 00:00:00
abstract：BACKGROUND:For patients with failed surgical treatment of an infected TKA, salvage operations such as arthrodesis or above-knee amputation (AKA) may be considered. Clinical and institutional factors associated with AKA and arthrodesis after a failed TKA have not been investigated in a large-scale population, and the ut...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1007/s11999-017-5285-x
更新日期：2017-12-01 00:00:00
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journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1981-07-01 00:00:00
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journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1990-06-01 00:00:00
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journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/01.blo.0000030075.92399.11
更新日期：2003-01-01 00:00:00
abstract：:Arthrographic study of the knee was performed in six patients for diagnosis of acute rupture of the quadriceps tendon. All of the patients gave a history of attempting to recover from a fall. Pain and tenderness over the suprapatellar area were common findings in all patients. Four patients had a positive arthrogram d...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1985-05-01 00:00:00
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journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章,评审
doi：
更新日期：1987-11-01 00:00:00
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journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章,评审
doi：10.1097/00003086-200209000-00004
更新日期：2002-09-01 00:00:00
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journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1983-04-01 00:00:00
abstract：:Osteolysis is defined as the process of progressive destruction of periprosthetic bony tissue, characterized on serial radiographs as progressive radiolucent lines and/or cavitation at the implant-bone or cement-bone interface. Without proper treatment, osteolysis may progress to aseptic loosening and catastrophic fai...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章,评审
doi：
更新日期：2004-10-01 00:00:00
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journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1978-03-01 00:00:00
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journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1984-05-01 00:00:00
abstract：:Eleven hips in eight patients with Ficat Stage II osteonecrosis were treated with core decompression and placement of an electrical stimulating coil in the anterior superior quadrant of the femoral head. The hips were followed two to five years (average, three and one-half years). Five hips required reoperation at an ...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1990-07-01 00:00:00
