Dickey Jones - Academia.edu (original) (raw)

Papers by Dickey Jones

The Infected Knee: All My Troubles Now

Journal of Arthroplasty, 2006

Infection after total knee arthroplasty poses formidable challenges to the surgeon. Once an infec... more Infection after total knee arthroplasty poses formidable challenges to the surgeon. Once an infection is diagnosed, the identification of the organism and its sensitivity to antibiotics is essential. The host's healing capacity is vital. Supplemental nutrition and cessation of smoking can improve wound healing. Surgical goals include debridement of necrotic tissue and elimination of the dead space. Intravenous antibiotics and a 2-stage protocol are the standard of care. At our institution, the first stage is performed with an implant and antibiotic-cement composite. This articulating spacer maintains limb length and tissue compliance. The patient can maintain a functional status between stages. Definitive reconstruction is more readily accomplished with this method in contrast to the static spacer approach. The clinical efficacy of this protocol has been well documented in the literature.

Metaphyseal fixation in revision total knee arthroplasty: indications and techniques

Journal of the American Academy of Orthopaedic Surgeons, 2011

The need for revision total knee arthroplasty (TKA) is on the rise. Challenges to attaining durab... more The need for revision total knee arthroplasty (TKA) is on the rise. Challenges to attaining durable, stable, well-functioning revision TKA include bony deficiency, periarticular osteopenia, deformity, and soft-tissue imbalance. Defect management often requires the use of stems, cement, metal augmentation, or allograft. Recently, there has been interest in obtaining fixation in the metaphyseal region in an attempt to improve construct stability while managing bony deficiency. Often, the metaphyseal bone is well vascularized, which provides an opportunity for additional fixation with cement, allograft, trabecular metal cones, or stepped porous-coated sleeves. Multiple series have documented good survivorship at short-term follow-up with trabecular metal cones and porous-coated sleeves. These newer technologies offer biologic fixation and are useful for treating bony defects that are not easily managed with other methods. Long-term studies are needed to determine the durability of thes...

Most problems encountered in complex revision total knee arthroplasty can be managed with the wid... more Most problems encountered in complex revision total knee arthroplasty can be managed with the wide range of implant systems currently available. Modular metaphyseal sleeves, metallic augments and cones provide stability even with significant bone loss. Hinged designs substitute for significant ligamentous deficiencies. Catastrophic failure that precludes successful reconstruction can be encountered. The alternatives to arthroplasty in such drastic situations include knee arthrodesis, resection arthroplasty and amputation. The relative indications for the selection of these alternatives are recurrent deep infection, immunocompromised host, and extensive non-reconstructible bone or soft-tissue defects.

Orthopedics, Mar 1, 2015

Patient-specific instrumentation (PSI) has been introduced as a tool to increase the accuracy of ... more Patient-specific instrumentation (PSI) has been introduced as a tool to increase the accuracy of total knee arthroplasty (TKA) compared with conventional instrumentation (CLI). However, previous studies have shown inconsistent results. The authors conducted a meta-analysis to compare the performance of PSI to CLI in TKA. PubMed, EMBASE, and Cochrane Central Register of Controlled Trials electronic databases were systematically searched to identify eligible trials published between 2000 and March 2014. Two reviewers independently assessed methodological quality according to the Cochrane Handbook. Subgroup analyses were performed based on the different study designs (randomized, controlled trial [RCT] vs nonrandomized, controlled trial [non-RCT]), preoperative magnetic resonance imaging vs computed tomography, and systems of PSI to explore the source of heterogeneity. Fourteen studies (7 RCTs and 7 non-RCTs) involving 1906 patients were included. There were no statistical differences with respect to the outliers of mechanical axis, coronal femoral component, sagittal femoral component, femoral component rotation, operative time, blood loss, and length of hospital stay between PSI and CLI groups. The number of outliers in coronal tibial components (odds ratio, 2.29; 95% confidence interval, 1.20 to 4.35; P=.01) and sagittal tibial components (odds ratio, 1.67; 95% confidence interval, 1.16 to 2.42; P<.01) was significantly lower in the CLI group than in the PSI group. Based on the numbers available, the use of PSI compared with CLI was not likely to improve the accuracy of component alignment and treatment effects of TKA. Further high-quality RCTs are warranted to confirm the authors' results. [Orthopedics. 2015; 38(3):e178-e188.]

Minimal incision surgery for total hip arthroplasty technique for anterior-lateral approach

Current Opinion in Orthopaedics

Fit and fill total hip arthroplasty: is it still efficacious?

Current Opinion in Orthopaedics, 2008

Total Knee Arthroplasty Without the Use of a Tourniquet

The major benefit of TKA with tourniquet is operating in a bloodless field. A possible secondary ... more The major benefit of TKA with tourniquet is operating in a bloodless field. A possible secondary benefit is a better cement bone interface for fixation. The disadvantages of tourniquet use for TKA include multiple risk factors both local and systemic including: nerve damage, altered hemodynamics with limb exsanguinations and reactive hyperemia with tourniquet release, delay in recovery of muscle or nerve function, increased risk of DVT with direct trauma to vessel walls and increased levels of thrombin-antithrombin complexes. A greater risk for large venous emboli propagation and transesophageal echogenic particles, vascular injury with higher risk in atherosclerotic, calcified arteries, and an increase in wound healing disturbances. Our initial experience with TKA without tourniquet was in high risk patients with previous DVT or PE, multiple scarring, or compromised cardiovascular status. We have used this method on all patients for the last eight years. The protocol includes regional anesthesia, incision and approach made with 90 degree knee flexion, meticulous hemostasis, jet lavage and filtered carbon dioxide delivered to dry and prepare bone beds for cementation and routine closure. We have encountered no differences in blood loss or transfusion rates, less post-op pain, faster straight leg raise and knee flexion gains, and fewer wound healing disturbances. We recommend TKA without tourniquet.

Preoperative flexion does not influence postoperative flexion after rotating-platform total knee arthroplasty

Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2014

Preoperative range of motion (ROM) has been regarded as one of the most important factors in pred... more Preoperative range of motion (ROM) has been regarded as one of the most important factors in predicting postoperative ROM following total knee arthroplasty (TKA). Mobile-bearing TKA designs have been suggested to possibly improve the knee kinematics compared to fixed-bearing designs. The purpose of this study was to examine the difference in postoperative flexion as a function of preoperative flexion in a consecutive series of TKAs done using a posterior-stabilized rotating-platform prosthesis. ROM was assessed in 153 consecutive TKAs done using a rotating-platform posterior cruciate-substituting design. Patients were divided into two groups based on their preoperative ROM (Group 1 < 95°, Group 2 > 95°). The Knee Society Score (KSS) and ROM were assessed preoperatively, 3 months and 12 months postoperatively. There was no difference in flexion 12 months after surgery between groups (mean 120° and 123°, respectively. n.s.). After 3 month follow-up, no increase in ROM was experi...

Metaphyseal fixation in revision total knee arthroplasty: indications and techniques

The Journal of the American Academy of Orthopaedic Surgeons, 2011

The need for revision total knee arthroplasty (TKA) is on the rise. Challenges to attaining durab... more The need for revision total knee arthroplasty (TKA) is on the rise. Challenges to attaining durable, stable, well-functioning revision TKA include bony deficiency, periarticular osteopenia, deformity, and soft-tissue imbalance. Defect management often requires the use of stems, cement, metal augmentation, or allograft. Recently, there has been interest in obtaining fixation in the metaphyseal region in an attempt to improve construct stability while managing bony deficiency. Often, the metaphyseal bone is well vascularized, which provides an opportunity for additional fixation with cement, allograft, trabecular metal cones, or stepped porous-coated sleeves. Multiple series have documented good survivorship at short-term follow-up with trabecular metal cones and porous-coated sleeves. These newer technologies offer biologic fixation and are useful for treating bony defects that are not easily managed with other methods. Long-term studies are needed to determine the durability of thes...

Rotating platform knees: An emerging clinical standard - In opposition

The Journal of Arthroplasty

As surgeons, we share the common goals of making total knee arthroplasty as reliable, as reproduc... more As surgeons, we share the common goals of making total knee arthroplasty as reliable, as reproducible, and as durable as we can. For that reason, we are almost compelled to investigate the rotating platform knee because of the contentions that it might improve patellar tracking, decrease lateral release rates, improve flexion, or perhaps give better wear characteristics over the long term. But when we take a step back and carefully examine the scientific data from 20 years of clinical experience with the rotating platform knee, the data speak for itself. To date, there are no demonstrated clinical advantages in regard to wear, survivorship, kinematics, range of motion, or patellar function. The rotating platform design then is really just another knee design, clinically indistinguishable from many well-functioning, fixed-bearing total knee designs.

The Infected Knee: All My Troubles Now

Journal of Arthroplasty, 2006

Infection after total knee arthroplasty poses formidable challenges to the surgeon. Once an infec... more Infection after total knee arthroplasty poses formidable challenges to the surgeon. Once an infection is diagnosed, the identification of the organism and its sensitivity to antibiotics is essential. The host&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s healing capacity is vital. Supplemental nutrition and cessation of smoking can improve wound healing. Surgical goals include debridement of necrotic tissue and elimination of the dead space. Intravenous antibiotics and a 2-stage protocol are the standard of care. At our institution, the first stage is performed with an implant and antibiotic-cement composite. This articulating spacer maintains limb length and tissue compliance. The patient can maintain a functional status between stages. Definitive reconstruction is more readily accomplished with this method in contrast to the static spacer approach. The clinical efficacy of this protocol has been well documented in the literature.

Metaphyseal fixation in revision total knee arthroplasty: indications and techniques

Journal of the American Academy of Orthopaedic Surgeons, 2011

The need for revision total knee arthroplasty (TKA) is on the rise. Challenges to attaining durab... more The need for revision total knee arthroplasty (TKA) is on the rise. Challenges to attaining durable, stable, well-functioning revision TKA include bony deficiency, periarticular osteopenia, deformity, and soft-tissue imbalance. Defect management often requires the use of stems, cement, metal augmentation, or allograft. Recently, there has been interest in obtaining fixation in the metaphyseal region in an attempt to improve construct stability while managing bony deficiency. Often, the metaphyseal bone is well vascularized, which provides an opportunity for additional fixation with cement, allograft, trabecular metal cones, or stepped porous-coated sleeves. Multiple series have documented good survivorship at short-term follow-up with trabecular metal cones and porous-coated sleeves. These newer technologies offer biologic fixation and are useful for treating bony defects that are not easily managed with other methods. Long-term studies are needed to determine the durability of thes...

Most problems encountered in complex revision total knee arthroplasty can be managed with the wid... more Most problems encountered in complex revision total knee arthroplasty can be managed with the wide range of implant systems currently available. Modular metaphyseal sleeves, metallic augments and cones provide stability even with significant bone loss. Hinged designs substitute for significant ligamentous deficiencies. Catastrophic failure that precludes successful reconstruction can be encountered. The alternatives to arthroplasty in such drastic situations include knee arthrodesis, resection arthroplasty and amputation. The relative indications for the selection of these alternatives are recurrent deep infection, immunocompromised host, and extensive non-reconstructible bone or soft-tissue defects.

Orthopedics, Mar 1, 2015

Patient-specific instrumentation (PSI) has been introduced as a tool to increase the accuracy of ... more Patient-specific instrumentation (PSI) has been introduced as a tool to increase the accuracy of total knee arthroplasty (TKA) compared with conventional instrumentation (CLI). However, previous studies have shown inconsistent results. The authors conducted a meta-analysis to compare the performance of PSI to CLI in TKA. PubMed, EMBASE, and Cochrane Central Register of Controlled Trials electronic databases were systematically searched to identify eligible trials published between 2000 and March 2014. Two reviewers independently assessed methodological quality according to the Cochrane Handbook. Subgroup analyses were performed based on the different study designs (randomized, controlled trial [RCT] vs nonrandomized, controlled trial [non-RCT]), preoperative magnetic resonance imaging vs computed tomography, and systems of PSI to explore the source of heterogeneity. Fourteen studies (7 RCTs and 7 non-RCTs) involving 1906 patients were included. There were no statistical differences with respect to the outliers of mechanical axis, coronal femoral component, sagittal femoral component, femoral component rotation, operative time, blood loss, and length of hospital stay between PSI and CLI groups. The number of outliers in coronal tibial components (odds ratio, 2.29; 95% confidence interval, 1.20 to 4.35; P=.01) and sagittal tibial components (odds ratio, 1.67; 95% confidence interval, 1.16 to 2.42; P<.01) was significantly lower in the CLI group than in the PSI group. Based on the numbers available, the use of PSI compared with CLI was not likely to improve the accuracy of component alignment and treatment effects of TKA. Further high-quality RCTs are warranted to confirm the authors' results. [Orthopedics. 2015; 38(3):e178-e188.]

Minimal incision surgery for total hip arthroplasty technique for anterior-lateral approach

Current Opinion in Orthopaedics

Fit and fill total hip arthroplasty: is it still efficacious?

Current Opinion in Orthopaedics, 2008

Total Knee Arthroplasty Without the Use of a Tourniquet

The major benefit of TKA with tourniquet is operating in a bloodless field. A possible secondary ... more The major benefit of TKA with tourniquet is operating in a bloodless field. A possible secondary benefit is a better cement bone interface for fixation. The disadvantages of tourniquet use for TKA include multiple risk factors both local and systemic including: nerve damage, altered hemodynamics with limb exsanguinations and reactive hyperemia with tourniquet release, delay in recovery of muscle or nerve function, increased risk of DVT with direct trauma to vessel walls and increased levels of thrombin-antithrombin complexes. A greater risk for large venous emboli propagation and transesophageal echogenic particles, vascular injury with higher risk in atherosclerotic, calcified arteries, and an increase in wound healing disturbances. Our initial experience with TKA without tourniquet was in high risk patients with previous DVT or PE, multiple scarring, or compromised cardiovascular status. We have used this method on all patients for the last eight years. The protocol includes regional anesthesia, incision and approach made with 90 degree knee flexion, meticulous hemostasis, jet lavage and filtered carbon dioxide delivered to dry and prepare bone beds for cementation and routine closure. We have encountered no differences in blood loss or transfusion rates, less post-op pain, faster straight leg raise and knee flexion gains, and fewer wound healing disturbances. We recommend TKA without tourniquet.

Preoperative flexion does not influence postoperative flexion after rotating-platform total knee arthroplasty

Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2014

Preoperative range of motion (ROM) has been regarded as one of the most important factors in pred... more Preoperative range of motion (ROM) has been regarded as one of the most important factors in predicting postoperative ROM following total knee arthroplasty (TKA). Mobile-bearing TKA designs have been suggested to possibly improve the knee kinematics compared to fixed-bearing designs. The purpose of this study was to examine the difference in postoperative flexion as a function of preoperative flexion in a consecutive series of TKAs done using a posterior-stabilized rotating-platform prosthesis. ROM was assessed in 153 consecutive TKAs done using a rotating-platform posterior cruciate-substituting design. Patients were divided into two groups based on their preoperative ROM (Group 1 < 95°, Group 2 > 95°). The Knee Society Score (KSS) and ROM were assessed preoperatively, 3 months and 12 months postoperatively. There was no difference in flexion 12 months after surgery between groups (mean 120° and 123°, respectively. n.s.). After 3 month follow-up, no increase in ROM was experi...

Metaphyseal fixation in revision total knee arthroplasty: indications and techniques

The Journal of the American Academy of Orthopaedic Surgeons, 2011

The need for revision total knee arthroplasty (TKA) is on the rise. Challenges to attaining durab... more The need for revision total knee arthroplasty (TKA) is on the rise. Challenges to attaining durable, stable, well-functioning revision TKA include bony deficiency, periarticular osteopenia, deformity, and soft-tissue imbalance. Defect management often requires the use of stems, cement, metal augmentation, or allograft. Recently, there has been interest in obtaining fixation in the metaphyseal region in an attempt to improve construct stability while managing bony deficiency. Often, the metaphyseal bone is well vascularized, which provides an opportunity for additional fixation with cement, allograft, trabecular metal cones, or stepped porous-coated sleeves. Multiple series have documented good survivorship at short-term follow-up with trabecular metal cones and porous-coated sleeves. These newer technologies offer biologic fixation and are useful for treating bony defects that are not easily managed with other methods. Long-term studies are needed to determine the durability of thes...

Rotating platform knees: An emerging clinical standard - In opposition

The Journal of Arthroplasty

As surgeons, we share the common goals of making total knee arthroplasty as reliable, as reproduc... more As surgeons, we share the common goals of making total knee arthroplasty as reliable, as reproducible, and as durable as we can. For that reason, we are almost compelled to investigate the rotating platform knee because of the contentions that it might improve patellar tracking, decrease lateral release rates, improve flexion, or perhaps give better wear characteristics over the long term. But when we take a step back and carefully examine the scientific data from 20 years of clinical experience with the rotating platform knee, the data speak for itself. To date, there are no demonstrated clinical advantages in regard to wear, survivorship, kinematics, range of motion, or patellar function. The rotating platform design then is really just another knee design, clinically indistinguishable from many well-functioning, fixed-bearing total knee designs.