Aaron Rosenberg - Academia.edu (original) (raw)

Papers by Aaron Rosenberg

Research paper thumbnail of Early failure of acetabular components inserted without cement after previous pelvic irradiation

Journal of Bone and Joint Surgery, American Volume, Dec 1, 1995

The effect of previous irradiation of the pelvis on the survival of acetabular components inserte... more The effect of previous irradiation of the pelvis on the survival of acetabular components inserted without cement in primary total hip arthroplasty was examined. We searched a database of 1319 patients who had been managed with a primary total hip arthroplasty with insertion of a hemispherical porous-coated acetabular component without cement. This revealed twelve hips in eleven patients who had been managed with previous irradiation of the pelvis. Three patients had died after less than one year of follow-up, leaving eight patients with nine acetabular components available for study at an average of thirty-seven months (range, seventeen to seventy-eight months) after the operation. The type of radiation as well as the fractionation, dose, and portals were reviewed to determine the exposure of the periacetabular region to radiation. Failure of the component was assessed radiographically and clinically. At the time of follow-up, three of the nine acetabular components had migrated, as seen on radiographs, and had been associated with progressive radiolucency without clinical symptoms. Thus, four of the nine acetabular components failed, at an average of twenty-five months (range, sixteen to thirty-eight months). The other five components had not failed clinically and were stable radiographically at an average of thirty-six months (range, seventeen to sixty-three months). The insertion of acetabular components without cement in a previously irradiated pelvis has a high rate of failure. However, a superior method of acetabular reconstruction in this difficult situation has yet to emerge.

Research paper thumbnail of A comparison of cemented and cementless fixation with the Miller-Galante total knee arthroplasty

PubMed, 1989

This study demonstrates the comparability of cemented and cementless fixation in total knee arthr... more This study demonstrates the comparability of cemented and cementless fixation in total knee arthroplasty at short-term follow-up. While some differences in pain, limp, and support were noted, knee scores were equivalent. Roentgenographic analysis as well as implant retrieval studies demonstrate that porous ingrowth is a viable method of fixation of total knee components. Further long-term follow-up studies will be required to determine both the long-term clinical results and the longevity of the fixation interface.

Research paper thumbnail of Heterotopic Ossification Prophylaxis After Total Hip Arthroplasty: Randomized Trial of 400 vs 700 cGy

Journal of Arthroplasty, Apr 1, 2017

Research paper thumbnail of Posterior Cruciate Ligament-Retaining Total Knee Arthroplasty in Patients with Rheumatoid Arthritis

Journal of Bone and Joint Surgery, American Volume, Aug 1, 2001

Research paper thumbnail of Preventing Leg Length Discrepancy and Instability After Total Hip Arthroplasty

PubMed, 2016

Restoration of equal leg lengths and dynamic hip stability are essential elements of a successful... more Restoration of equal leg lengths and dynamic hip stability are essential elements of a successful total hip arthroplasty. A careful clinical examination, a preoperative plan, and appropriate intraoperative techniques are necessary to achieve these goals. Preoperative identification of patients at risk for residual leg length discrepancy allows surgeons to adjust the surgical approach and/or the type of implant and provide better preoperative patient education. The use of larger femoral heads, high-offset stem options, and enhanced soft-tissue repairs have improved impingement-free range of motion as well as dynamic hip stability and have contributed to an overall reduction in dislocation. Methods for accurate leg length restoration and component positioning include anatomic landmarks, intraoperative radiographs, intraoperative calipers, stability testing, and computer-assisted surgery. If recurrent instability occurs after total hip arthroplasty, the underlying cause for dislocation should be identified and treated; this may include the use of semiconstrained dual-mobility or fully constrained liners, depending on abductor function. Surgeons should be aware of the clinical and surgical techniques for achieving leg length equalization and dynamic hip stability in total hip arthroplasty.

Research paper thumbnail of Does Hip Arthroscopy Affect the Outcomes of a Subsequent Total Hip Arthroplasty?

Journal of Arthroplasty, Jul 1, 2016

Research paper thumbnail of Isolated Revision of the Patellar Component in Total Knee Arthroplasty

Journal of Bone and Joint Surgery, American Volume, 2003

Problems with the patellofemoral articulation are the most common causes of failure after total k... more Problems with the patellofemoral articulation are the most common causes of failure after total knee arthroplasty. However, there are few reports describing outcomes following isolated revision of the patellar component. Forty knees with a Miller-Galante I prosthesis underwent isolated patellar revision (with or without lateral retinacular release). The Hospital for Special Surgery knee scores were collected prospectively, and radiographs made preoperatively and at the time of the final follow-up were analyzed with respect to alignment, component position, and patellar tracking. Particular attention was given to patients who had a reoperation or repeat revision and who had clinical or radiographic evidence of failure of the patellar revision. At a mean follow-up of sixty-two months, fifteen (38%) of the forty knees that had had an isolated revision of the patellar component failed a second time. Eight of them required a total of twelve additional operations at a mean of forty-nine months after the patellar revision. Three of the failures were severe enough to require revision of two or more of the components. Of the twenty-five knees that had not failed, the average Hospital for Special Surgery knee score at the time of the final follow-up was 87 points. Of the seven knees that did not undergo reoperation but were deemed to be failures on the basis of the patients' symptoms, the average Hospital for Special Surgery knee score at the time of the final follow-up was 72 points. Isolated patellar revision, with or without concurrent lateral retinacular release, was associated with a high rate of reoperation and a relatively low rate of success. Elements of the implant design and component alignment contributed to the patellar component failure; both should be scrutinized carefully in patients who are seen with this problem, prior to proceeding with isolated revision of the patellar component of a total knee arthroplasty. Therapeutic study, Level IV (case series [no, or historical, control group]). See p. 2 for complete description of levels of evidence.

Research paper thumbnail of Reconstructive Options for Osteonecrosis of the Femoral Head

Techniques in Orthopaedics, Mar 1, 2001

... Ivankovich, Daniel Anthony MD; Rosenberg, Aaron Glen MD; Malamis, Angelo BS. Article Outline.... more ... Ivankovich, Daniel Anthony MD; Rosenberg, Aaron Glen MD; Malamis, Angelo BS. Article Outline. Collapse Box Author Information. From the Department of Orthopaedic Surgery, Section of Adult Reconstruction, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois. ...

Research paper thumbnail of Revision Total Knee Arthroplasty

Journal of the American Academy of Orthopaedic Surgeons, Aug 1, 2008

Abstract Revision total knee arthroplasty presents numerous technical challenges and decisions fo... more Abstract Revision total knee arthroplasty presents numerous technical challenges and decisions for the operating surgeon. Preoperative planning includes critically reviewing radiographs and ordering necessary equipment, including prosthetic components, extraction devices, and bone graft materials. In some cases, surgical exposure requires the use of extensile exposure techniques. Component removal is facilitated by the use of appropriate tools (eg, specialized osteotomes) as well as by the patience to ensure preservation of host bone. Bone loss is managed with bone grafts or prosthetic augmentation. Attention to balancing the flexion and extension gaps is essential to avoid problems with instability as well as excessively constrained prosthetic components. Intramedullary stem extensions improve long‐term clinical results. Intraoperative extensor mechanism complications can be avoided with meticulous surgical technique; late complications may require surgical intervention.

Research paper thumbnail of Unicompartmental knee arthroplasty. Clinical experience at 6- to 10-year followup

PubMed, Oct 1, 1999

Sixty-two consecutive cemented modular unicompartmental knee arthroplasties in 51 patients were s... more Sixty-two consecutive cemented modular unicompartmental knee arthroplasties in 51 patients were studied prospectively. At surgery, the other compartments had at most Grade 2 chondromalacia. The average age of the patients at arthroplasty was 68 years (range, 51-84 years). One patient was lost to followup and 10 died with less than 6 years followup. The average followup of the remaining 51 knees was 7.5 years (range, 6-10 years). The preoperative Hospital for Special Surgery knee score of 55 points (range, 30-79 points) improved to 92 points (range, 60-100 points) at followup; 78% (40 knees) had excellent and 20% (10 knees) had good results. The mean range of motion at followup was 120 degrees with 26 knees (51%) having range of motion greater than 120 degrees. One patient underwent revision surgery for retained cement, one patient underwent knee manipulation, and one patient underwent revision surgery at 7 years for opposite compartment degeneration and pain. Radiographically, 26 knees (51%) had at least one partial radiolucency. There were no complete femoral radiolucencies, but there were three complete tibial radiolucencies, all less than 2 mm. No component was loose as seen on radiographs. At final followup, five of the opposite compartments (10%) and three of the patellofemoral joints (6%) had some progressive radiographic joint space loss; this was less than a 25% loss in all but one knee component that was revised. At 6- to 10-years followup, cemented unicompartmental knee arthroplasty yielded excellent clinical and radiographic results. The 10-year survival using radiographic loosening or revision as the end point was 98%. Using stringent selection criteria, unicompartmental knee replacement can yield excellent results and represents a superb alternative to total knee replacement.

Research paper thumbnail of Recurrent hemarthrosis following total knee arthroplasty. Report of a case treated with arterial embolization

Research paper thumbnail of Modified Hybrid Stem Fixation in Revision TKA is Durable at 2 to 10 Years

Clinical Orthopaedics and Related Research, Mar 1, 2011

Research paper thumbnail of Perioperative Testing for Sepsis in Revision Total Knee Arthroplasty

The Journal of Arthroplasty, 2007

Research paper thumbnail of Case challenges in knee surgery: What would you do?

Journal of Arthroplasty, Apr 1, 2003

This case discussion features knee arthroplasty cases presented to a panel of surgeons. The cases... more This case discussion features knee arthroplasty cases presented to a panel of surgeons. The cases were chosen to represent common clinical problems encountered in everyday practice.

Research paper thumbnail of Comparison of a Standard and a Gender-Specific Posterior Cruciate-Substituting High-Flexion Knee Prosthesis. A Prospective, Randomized, Short-Term Outcome Study

Journal of Bone and Joint Surgery, American Volume, Feb 1, 2011

Research paper thumbnail of What Would YOU Do?

Journal of Arthroplasty, Jun 1, 2006

The panel reviewed cases involving both revision and primary total hip arthroplasties. The paneli... more The panel reviewed cases involving both revision and primary total hip arthroplasties. The panelists are Hugh Cameron and Allan Gross from Toronto, Charles Engh from Arlington, Aaron Rosenberg from Chicago, and Bernard Stulberg from Cleveland. The cases discussed brought up some controversial issues.

Research paper thumbnail of Revision total knee arthroplasty

Current Opinion in Orthopaedics, Feb 1, 1996

Research paper thumbnail of Cemented and Ingrowth Fixation of the Miller???Galante Prosthesis

Clinical Orthopaedics and Related Research, Nov 1, 1990

One hundred thirty-nine cemented and 132 cementless Miller-Galante total knee prostheses were fol... more One hundred thirty-nine cemented and 132 cementless Miller-Galante total knee prostheses were followed between three and six years (average, 43-44 months). The fixation technique was based on patient age, bone quality, and ability to delay full-weight bearing. Clinical follow-up studies were possible on 116 cemented knees. Fifteen knees were lost because of death before the three-year follow-up study, and eight knees required component removal. One hundred twenty-three cementless knees were available for clinical follow-up studies; there were three deaths, and six failures required component removal. No cemented failure was due to fixation, and three cementless failures were due to lack of tibial ingrowth in two and pain of undetermined etiology in one. Preoperative knee scores were slightly significant with cemented knees averaging 48 points and cementless knees averaging 52 points. A similar significant difference was maintained at the final follow-up study. No significant differences were noted for pain, limp, or support scores. Average range of motion was similar in the two groups. Radiolucent lines about the femoral component were rare. Cementless tibial radiolucencies were partial in up to 20% of examined zones, and complete tibial tray radiolucency was seen in only three patients. No correlation between radiolucency and knee scores was seen.

Research paper thumbnail of Arthroplasty with a composite of an allograft and a prosthesis for knees with severe deficiency of bone

Journal of Bone and Joint Surgery, American Volume, Mar 1, 1995

We reviewed the clinical and radiographic results of fourteen patients who had a severe deficienc... more We reviewed the clinical and radiographic results of fourteen patients who had a severe deficiency of bone and were managed with a massive allograft in conjunction with a standard total knee prosthesis between 1987 and 1990. The etiology of the bone loss included the failure of a previous total knee prosthesis, a supracondylar fracture of the femur or a fracture of the proximal part of the tibia, and débridement during the first stage of a reconstruction for the treatment of an infection. Thirteen patients had satisfactory clinical and radiographic results after the index procedure. The knee score of The Hospital for Special Surgery improved from an average of 24 points (range, 0 to 54 points) preoperatively to 82 points (range, 37 to 98 points) at the time of the most recent follow-up examination. The average duration of follow-up was forty-three months (range, twenty-nine to sixty-three months). The radiographic and functional results compare favorably with those that have been reported in most studies of otherwise comparable patients who had less deficiency of bone. While considerable risks are associated with the use of allograft bone and the true longevity of reconstructions with such bone is not yet known, the initial and short-term follow-up results support the use of allograft for the restoration of a functional knee joint in a patient who has a severe deficiency of bone.

Research paper thumbnail of Letter to the Editor: Editorial: Transition From Training to Practice - Is There a Better Way?

Clinical Orthopaedics and Related Research, Nov 1, 2014

Research paper thumbnail of Early failure of acetabular components inserted without cement after previous pelvic irradiation

Journal of Bone and Joint Surgery, American Volume, Dec 1, 1995

The effect of previous irradiation of the pelvis on the survival of acetabular components inserte... more The effect of previous irradiation of the pelvis on the survival of acetabular components inserted without cement in primary total hip arthroplasty was examined. We searched a database of 1319 patients who had been managed with a primary total hip arthroplasty with insertion of a hemispherical porous-coated acetabular component without cement. This revealed twelve hips in eleven patients who had been managed with previous irradiation of the pelvis. Three patients had died after less than one year of follow-up, leaving eight patients with nine acetabular components available for study at an average of thirty-seven months (range, seventeen to seventy-eight months) after the operation. The type of radiation as well as the fractionation, dose, and portals were reviewed to determine the exposure of the periacetabular region to radiation. Failure of the component was assessed radiographically and clinically. At the time of follow-up, three of the nine acetabular components had migrated, as seen on radiographs, and had been associated with progressive radiolucency without clinical symptoms. Thus, four of the nine acetabular components failed, at an average of twenty-five months (range, sixteen to thirty-eight months). The other five components had not failed clinically and were stable radiographically at an average of thirty-six months (range, seventeen to sixty-three months). The insertion of acetabular components without cement in a previously irradiated pelvis has a high rate of failure. However, a superior method of acetabular reconstruction in this difficult situation has yet to emerge.

Research paper thumbnail of A comparison of cemented and cementless fixation with the Miller-Galante total knee arthroplasty

PubMed, 1989

This study demonstrates the comparability of cemented and cementless fixation in total knee arthr... more This study demonstrates the comparability of cemented and cementless fixation in total knee arthroplasty at short-term follow-up. While some differences in pain, limp, and support were noted, knee scores were equivalent. Roentgenographic analysis as well as implant retrieval studies demonstrate that porous ingrowth is a viable method of fixation of total knee components. Further long-term follow-up studies will be required to determine both the long-term clinical results and the longevity of the fixation interface.

Research paper thumbnail of Heterotopic Ossification Prophylaxis After Total Hip Arthroplasty: Randomized Trial of 400 vs 700 cGy

Journal of Arthroplasty, Apr 1, 2017

Research paper thumbnail of Posterior Cruciate Ligament-Retaining Total Knee Arthroplasty in Patients with Rheumatoid Arthritis

Journal of Bone and Joint Surgery, American Volume, Aug 1, 2001

Research paper thumbnail of Preventing Leg Length Discrepancy and Instability After Total Hip Arthroplasty

PubMed, 2016

Restoration of equal leg lengths and dynamic hip stability are essential elements of a successful... more Restoration of equal leg lengths and dynamic hip stability are essential elements of a successful total hip arthroplasty. A careful clinical examination, a preoperative plan, and appropriate intraoperative techniques are necessary to achieve these goals. Preoperative identification of patients at risk for residual leg length discrepancy allows surgeons to adjust the surgical approach and/or the type of implant and provide better preoperative patient education. The use of larger femoral heads, high-offset stem options, and enhanced soft-tissue repairs have improved impingement-free range of motion as well as dynamic hip stability and have contributed to an overall reduction in dislocation. Methods for accurate leg length restoration and component positioning include anatomic landmarks, intraoperative radiographs, intraoperative calipers, stability testing, and computer-assisted surgery. If recurrent instability occurs after total hip arthroplasty, the underlying cause for dislocation should be identified and treated; this may include the use of semiconstrained dual-mobility or fully constrained liners, depending on abductor function. Surgeons should be aware of the clinical and surgical techniques for achieving leg length equalization and dynamic hip stability in total hip arthroplasty.

Research paper thumbnail of Does Hip Arthroscopy Affect the Outcomes of a Subsequent Total Hip Arthroplasty?

Journal of Arthroplasty, Jul 1, 2016

Research paper thumbnail of Isolated Revision of the Patellar Component in Total Knee Arthroplasty

Journal of Bone and Joint Surgery, American Volume, 2003

Problems with the patellofemoral articulation are the most common causes of failure after total k... more Problems with the patellofemoral articulation are the most common causes of failure after total knee arthroplasty. However, there are few reports describing outcomes following isolated revision of the patellar component. Forty knees with a Miller-Galante I prosthesis underwent isolated patellar revision (with or without lateral retinacular release). The Hospital for Special Surgery knee scores were collected prospectively, and radiographs made preoperatively and at the time of the final follow-up were analyzed with respect to alignment, component position, and patellar tracking. Particular attention was given to patients who had a reoperation or repeat revision and who had clinical or radiographic evidence of failure of the patellar revision. At a mean follow-up of sixty-two months, fifteen (38%) of the forty knees that had had an isolated revision of the patellar component failed a second time. Eight of them required a total of twelve additional operations at a mean of forty-nine months after the patellar revision. Three of the failures were severe enough to require revision of two or more of the components. Of the twenty-five knees that had not failed, the average Hospital for Special Surgery knee score at the time of the final follow-up was 87 points. Of the seven knees that did not undergo reoperation but were deemed to be failures on the basis of the patients' symptoms, the average Hospital for Special Surgery knee score at the time of the final follow-up was 72 points. Isolated patellar revision, with or without concurrent lateral retinacular release, was associated with a high rate of reoperation and a relatively low rate of success. Elements of the implant design and component alignment contributed to the patellar component failure; both should be scrutinized carefully in patients who are seen with this problem, prior to proceeding with isolated revision of the patellar component of a total knee arthroplasty. Therapeutic study, Level IV (case series [no, or historical, control group]). See p. 2 for complete description of levels of evidence.

Research paper thumbnail of Reconstructive Options for Osteonecrosis of the Femoral Head

Techniques in Orthopaedics, Mar 1, 2001

... Ivankovich, Daniel Anthony MD; Rosenberg, Aaron Glen MD; Malamis, Angelo BS. Article Outline.... more ... Ivankovich, Daniel Anthony MD; Rosenberg, Aaron Glen MD; Malamis, Angelo BS. Article Outline. Collapse Box Author Information. From the Department of Orthopaedic Surgery, Section of Adult Reconstruction, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois. ...

Research paper thumbnail of Revision Total Knee Arthroplasty

Journal of the American Academy of Orthopaedic Surgeons, Aug 1, 2008

Abstract Revision total knee arthroplasty presents numerous technical challenges and decisions fo... more Abstract Revision total knee arthroplasty presents numerous technical challenges and decisions for the operating surgeon. Preoperative planning includes critically reviewing radiographs and ordering necessary equipment, including prosthetic components, extraction devices, and bone graft materials. In some cases, surgical exposure requires the use of extensile exposure techniques. Component removal is facilitated by the use of appropriate tools (eg, specialized osteotomes) as well as by the patience to ensure preservation of host bone. Bone loss is managed with bone grafts or prosthetic augmentation. Attention to balancing the flexion and extension gaps is essential to avoid problems with instability as well as excessively constrained prosthetic components. Intramedullary stem extensions improve long‐term clinical results. Intraoperative extensor mechanism complications can be avoided with meticulous surgical technique; late complications may require surgical intervention.

Research paper thumbnail of Unicompartmental knee arthroplasty. Clinical experience at 6- to 10-year followup

PubMed, Oct 1, 1999

Sixty-two consecutive cemented modular unicompartmental knee arthroplasties in 51 patients were s... more Sixty-two consecutive cemented modular unicompartmental knee arthroplasties in 51 patients were studied prospectively. At surgery, the other compartments had at most Grade 2 chondromalacia. The average age of the patients at arthroplasty was 68 years (range, 51-84 years). One patient was lost to followup and 10 died with less than 6 years followup. The average followup of the remaining 51 knees was 7.5 years (range, 6-10 years). The preoperative Hospital for Special Surgery knee score of 55 points (range, 30-79 points) improved to 92 points (range, 60-100 points) at followup; 78% (40 knees) had excellent and 20% (10 knees) had good results. The mean range of motion at followup was 120 degrees with 26 knees (51%) having range of motion greater than 120 degrees. One patient underwent revision surgery for retained cement, one patient underwent knee manipulation, and one patient underwent revision surgery at 7 years for opposite compartment degeneration and pain. Radiographically, 26 knees (51%) had at least one partial radiolucency. There were no complete femoral radiolucencies, but there were three complete tibial radiolucencies, all less than 2 mm. No component was loose as seen on radiographs. At final followup, five of the opposite compartments (10%) and three of the patellofemoral joints (6%) had some progressive radiographic joint space loss; this was less than a 25% loss in all but one knee component that was revised. At 6- to 10-years followup, cemented unicompartmental knee arthroplasty yielded excellent clinical and radiographic results. The 10-year survival using radiographic loosening or revision as the end point was 98%. Using stringent selection criteria, unicompartmental knee replacement can yield excellent results and represents a superb alternative to total knee replacement.

Research paper thumbnail of Recurrent hemarthrosis following total knee arthroplasty. Report of a case treated with arterial embolization

Research paper thumbnail of Modified Hybrid Stem Fixation in Revision TKA is Durable at 2 to 10 Years

Clinical Orthopaedics and Related Research, Mar 1, 2011

Research paper thumbnail of Perioperative Testing for Sepsis in Revision Total Knee Arthroplasty

The Journal of Arthroplasty, 2007

Research paper thumbnail of Case challenges in knee surgery: What would you do?

Journal of Arthroplasty, Apr 1, 2003

This case discussion features knee arthroplasty cases presented to a panel of surgeons. The cases... more This case discussion features knee arthroplasty cases presented to a panel of surgeons. The cases were chosen to represent common clinical problems encountered in everyday practice.

Research paper thumbnail of Comparison of a Standard and a Gender-Specific Posterior Cruciate-Substituting High-Flexion Knee Prosthesis. A Prospective, Randomized, Short-Term Outcome Study

Journal of Bone and Joint Surgery, American Volume, Feb 1, 2011

Research paper thumbnail of What Would YOU Do?

Journal of Arthroplasty, Jun 1, 2006

The panel reviewed cases involving both revision and primary total hip arthroplasties. The paneli... more The panel reviewed cases involving both revision and primary total hip arthroplasties. The panelists are Hugh Cameron and Allan Gross from Toronto, Charles Engh from Arlington, Aaron Rosenberg from Chicago, and Bernard Stulberg from Cleveland. The cases discussed brought up some controversial issues.

Research paper thumbnail of Revision total knee arthroplasty

Current Opinion in Orthopaedics, Feb 1, 1996

Research paper thumbnail of Cemented and Ingrowth Fixation of the Miller???Galante Prosthesis

Clinical Orthopaedics and Related Research, Nov 1, 1990

One hundred thirty-nine cemented and 132 cementless Miller-Galante total knee prostheses were fol... more One hundred thirty-nine cemented and 132 cementless Miller-Galante total knee prostheses were followed between three and six years (average, 43-44 months). The fixation technique was based on patient age, bone quality, and ability to delay full-weight bearing. Clinical follow-up studies were possible on 116 cemented knees. Fifteen knees were lost because of death before the three-year follow-up study, and eight knees required component removal. One hundred twenty-three cementless knees were available for clinical follow-up studies; there were three deaths, and six failures required component removal. No cemented failure was due to fixation, and three cementless failures were due to lack of tibial ingrowth in two and pain of undetermined etiology in one. Preoperative knee scores were slightly significant with cemented knees averaging 48 points and cementless knees averaging 52 points. A similar significant difference was maintained at the final follow-up study. No significant differences were noted for pain, limp, or support scores. Average range of motion was similar in the two groups. Radiolucent lines about the femoral component were rare. Cementless tibial radiolucencies were partial in up to 20% of examined zones, and complete tibial tray radiolucency was seen in only three patients. No correlation between radiolucency and knee scores was seen.

Research paper thumbnail of Arthroplasty with a composite of an allograft and a prosthesis for knees with severe deficiency of bone

Journal of Bone and Joint Surgery, American Volume, Mar 1, 1995

We reviewed the clinical and radiographic results of fourteen patients who had a severe deficienc... more We reviewed the clinical and radiographic results of fourteen patients who had a severe deficiency of bone and were managed with a massive allograft in conjunction with a standard total knee prosthesis between 1987 and 1990. The etiology of the bone loss included the failure of a previous total knee prosthesis, a supracondylar fracture of the femur or a fracture of the proximal part of the tibia, and débridement during the first stage of a reconstruction for the treatment of an infection. Thirteen patients had satisfactory clinical and radiographic results after the index procedure. The knee score of The Hospital for Special Surgery improved from an average of 24 points (range, 0 to 54 points) preoperatively to 82 points (range, 37 to 98 points) at the time of the most recent follow-up examination. The average duration of follow-up was forty-three months (range, twenty-nine to sixty-three months). The radiographic and functional results compare favorably with those that have been reported in most studies of otherwise comparable patients who had less deficiency of bone. While considerable risks are associated with the use of allograft bone and the true longevity of reconstructions with such bone is not yet known, the initial and short-term follow-up results support the use of allograft for the restoration of a functional knee joint in a patient who has a severe deficiency of bone.

Research paper thumbnail of Letter to the Editor: Editorial: Transition From Training to Practice - Is There a Better Way?

Clinical Orthopaedics and Related Research, Nov 1, 2014