James Stiehl - Academia.edu (original) (raw)

Papers by James Stiehl

Orthopedics, 2002

This article reviews recent data regarding the low contact stress (LCS) mobile-bearing total knee... more This article reviews recent data regarding the low contact stress (LCS) mobile-bearing total knee prosthesis recently published in the literature; conclusions are based on literature controls. The LCS Total Knee System (DePuy Orthopaedics Inc, Warsaw, Ind) has addressed the issues of implant polyethylene wear and implant-generated osteolysis. Patellar implant complications have been minimal despite the use of a mobile, metal-backed component. The original US Food and Drug Administration clinical investigation demonstrated favorable experience with cementless fixation. Results from numerous series indicate that the main problem with a mobile-bearing device is an early prosthetic failure resulting from bearing dislocation or breakage. Inadequate surgical technique will lead to femorotibial malalignment or ligamentous instability, which are factors that commonly result in revision. With the LCS Total Knee System, surgeons can use a tibia-cut-first approach with careful ligamentous balancing and flexion block spacing. The valgus lateral knee approach is an additional technique that has proved useful with this method.

Orthopedics, 2005

Biological ingrowth surfaces have become a standard prosthetic element in reconstructive hip surg... more Biological ingrowth surfaces have become a standard prosthetic element in reconstructive hip surgery. A material&amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s properties, three-dimensional architecture, and surface texture all play integral parts in its biological performance. Trabecular metal is an important new biomaterial that has been introduced to enhance the potential of biological ingrowth as well as provide a structural scaffold in cases of severe bone deficit. Initial clinical applications have focused on bone restoration in tumor and salvage cases and in primary and revision reconstructive cases where the increased biological fixation would be of clinical benefit. The bone ingrowth potential and mechanical integrity of this material offer exciting options for orthopedic reconstructive surgeons.

Clinical Orthopaedics and Related Research, 2018

The study by Ollivier and colleagues demonstrates that there is little difference in functional o... more The study by Ollivier and colleagues demonstrates that there is little difference in functional outcomes at 10 years for total knee replacements done with or without computer-assisted surgical (CAS) techniques. To date, few clinical series show clear clinical improvements with CAS. Previous studies [1, 2, 6, 8, 10, 13, 14] have shown that CAS can help surgeons address particular clinical needs, such as TKA in patients with severe joint deformities and patients in whom intramedullary instrumentation cannot be used. Additionally, CAS allows surgeons to measure and record ligament balancing parameters through the arc of motion during surgery, which may be useful for research, teaching, and, perhaps, clinical care. Without question, computer navigation has been shown from the outset to improve the precision of mechanical alignment and ligament balancing [3, 11, 15]. The challenge has been to deal with the complexity, added operative time, and costs encountered by early adopters of this technology. After 20 years of widespread clinical use in the international setting, computer navigation technology continues to improve with advances such as automated registration for CT imaging protocols, more efficient camera technology, and the ability to use extremely limited instrumentation sets.

The Journal of Bone and Joint Surgery. British volume, 1995

We used fluoroscopy to study the kinematics of the knee in 47 patients with total knee arthroplas... more We used fluoroscopy to study the kinematics of the knee in 47 patients with total knee arthroplasty (TKA) and four control subjects with normal knees while performing a single-leg deep-knee bend. The videos were analysed using still photographs taken at 5 degrees increments of flexion. Femorotibial contact points, patellar ligament rotation, and patellar rotation were calculated from each image. Maximum weight-bearing flexion was determined for each knee. Compared with the control group, posterior-cruciate-retaining TKA did not reproduce normal knee kinematics in any case, but showed a starting point posterior to the tibial midline which translated anteriorly with flexion. The curves from successive knee bends could not be consistently reproduced. Under weight-bearing conditions, the maximum flexion for any PCR TKA was 98 degrees and several patients could not flex beyond 70 degrees.

Foot & Ankle International, 2000

In vivo weight-bearing studies utilizing dynamic video fluoroscopy have been shown to offer an ac... more In vivo weight-bearing studies utilizing dynamic video fluoroscopy have been shown to offer an accurate and reproducible method for determining the kinematics of a joint. The purpose of this study was to evaluate translational and rotational motions of the distal tibia relative to the talus in the sagittal and frontal planes. Ten subjects, each having a normal ankle and a total ankle arthroplasty on the opposite side (Buechel-Pappas Total Ankle, Endotec, South Orange, NJ), were studied under in vivo, weight-bearing conditions using video fluoroscopy. All ten subjects were judged to have a successful arthroplasty without demonstrable pain or ligament instability. Under weight-bearing conditions, each subject performed successive motions moving from maximum dorsiflexion to plantarflexion. At maximum dorsiflexion, both the normal and implanted ankles had similar sagittal midline talar contact positions but with plantar flexion, implanted ankles had increased posterior talar contact. Co...

Clinical Orthopaedics and Related Research, 2008

Computer-assisted navigation is a surgical tool that may decrease malalignment outliers in TKA. W... more Computer-assisted navigation is a surgical tool that may decrease malalignment outliers in TKA. With any new surgical technique, there is the possibility of unexpected complications that raise caution. We report two patients with displaced femoral fractures at optical tracker pin placement sites created for routine performance of navigated TKA. Our experience suggests single bicortical 5-mm pins placed in the femoral shaft have the added risk of creating a stress riser leading to the potential for fracture. Females may have a higher risk for this complication. We believe bicortical pin fixation in the femur or tibia no longer is indicated.

Clinical orthopaedics and related research, Jan 22, 2016

Bone Joint Journal Orthopaedic Proceedings Supplement, Jul 1, 2014

In TKA, prosthetic femoral and tibial implants must be symmetrically placed and matched in the me... more In TKA, prosthetic femoral and tibial implants must be symmetrically placed and matched in the mechanical axis and the ligament gaps must be correctly balanced. The collateral ligaments are the key guide, as they arise from the epicondyles of the distal femur, are perpendicular to the AP axis of Whiteside, and are coincident with the transtibial axis of the proximal tibial surface. A perpendicular bisection of the transtibial axis creates the AP axis of the tibia which is coincident in space with the AP axis of Whiteside (Berger). Measured distal femoral resection targets including TEA, AP axis of Whiteside, and 3 degrees external to the posterior condylar axis works because the stout posterior cruciate ligament limits laxity in flexion, allowing for the anatomical variation of these landmarks to be accommodated. The Insall, Ranawat gap balancing methods work to balance the knee in flexion, often matching the results of a measured resection, but guaranteeing a symmetrically balanced flexion gap. Distal femoral internal rotation can result if the medial collateral is over-released, but experience has shown this not to be a problem if the gaps are well balanced. Tibial tray position must be placed coincident with the AP axis of the tibia, which also is coincident with Akagi9s line (line from medial margin of patellar tendon to center of the posterior cruciate ligament). The surgeon can make a line from the AP axis of Whiteside to the anterior tibial which matches the AP tibial axis.

Minimally Invasive Surgery in Orthopedics, 2016

Computer navigation is an important method in orthopedic surgery improving the accuracy and preci... more Computer navigation is an important method in orthopedic surgery improving the accuracy and precision of surgical interventions. The basic technology of digital imaging with digital cameras has improved to submicron accuracy. The ability to make the surgical targets virtual on a monitor has evolved to the point where the capabilities have exceeded the limitations of cost, complexity, and inefficiency. In addition, various parallel technologies such as intraoperative computed tomography will automate the registration process to a few seconds. Patient-specific cutting guides are another example of the example utilizing preoperative imaging to create custom cutting guides. National joint registry data from Australia have show that long-term revision rates are lower in patients who have had navigated total knees. Detractors still identify the precision problems of imageless registration, and pin complications for the bone anchoring of trackers have a small risk of stress fracture. The overall impression is that various digital imaging systems including robotics, intraoperative computed tomography, and other parallel technologies will produce a “better than not” scenario for the practicing surgeon.

Background: Septic shock and SIRS are life-threatening diseases with persistent high mortality. H... more Background: Septic shock and SIRS are life-threatening diseases with persistent high mortality. Hemoadsorption with CytoSorb ® offers a possible therapeutic approach, but the optimal timing, dosing and indications are still unclear. Methods: Observational data from 70 patients with septic shock or SIRS, treated in a university hospital with hemoadsorption by CytoSorb ® in addition to renal replacement therapy were analyzed retrospectively. Physiologic parameters and clinical outcomes were extracted from the electronic charts. The predicted mortality was calculated based on APACHE II and SOFA scores and compared with the actual 28-day survival. The total amount of blood puri ed was correlated with outcome. Results: The main origins of septic shock were abdominal (n=29) or pulmonary (n=22). The mean age was 70.6±13.3 years. Hemoadsorption was applied for 85.6±53.8h with 3.2±1.7 cycles lasting 26.75±11.1h each. The severity was characterized by a mean APACHE II score of 30.2±6.3 and SOFA score of 13.8±3.5, which calculated to a predicted mortality of 73.3% and 62.1%, respectively. The observed mortality was signi cantly lower (35/70 patients (50%), p<0.05). Interleukin-6 levels at baseline were high (survivors: 7964±11242pg/ml; nonsurvivors: 8.755±15.800pg/ml, p=0.27) and decreased rapidly within 4-24h. Survival was independently associated with lower IL-6 levels and norepinephrine dosage after 24h. An increase in IL-6 after 48h was predictive of poor outcome. The treatment duration and amount of blood puri ed was higher in survivors than in non-survivors (8.47±4.42 vs. 6.07±3.57l/kg BW, p=0.017). We identi ed 3 clusters of <6l/kg, 6-13l/kg and ≥13l/kg BW with a linear dose-response relation between blood puri cation volume and survival. Although the predicted mortality was comparable among the clusters (p=ns), survival was best in the highest volume cluster (16.7%; p=0.045). Conclusions: The application of CytoSorb ® seems to be safe and effective in various conditions of septic shock and SIRS, although the optimal duration and dosing remain unclear. In a cohort of severely ill patients the observed mortality rate was lower than predicted and decreased linearly with blood puri cation volumes exceeding 6l/kg BW. These results suggest that hemoadsorption with CytoSorb ® improves survival in septic shock or SIRS, provided that the applied dose is high enough.

Current Opinion in Orthopedics, 2001

The emergence of the mobile-bearing articulating polyethylene surfaces in total knee arthroplasty... more The emergence of the mobile-bearing articulating polyethylene surfaces in total knee arthroplasty reflects designers' efforts to optimize wear while dealing with complex function. In vivo dynamic video fluoroscopy has provided extensive knowledge of the precise articulation mechanisms in total knee arthroplasty. The convergence of kinematic data with the analysis of prosthetic retrievals from failed total knees has given a clear understanding of the functional requirements for improved mobile-bearing total knee devices. Design issues include femoral condyle geometry, single versus polycentric radius of curvature, devices that restrict certain bearing motions and disarticulation such as stops or pegs, a medial versus more central longitudinal axis of rotation on the proximal tibia, surgical technique, implant stability, contact area, and patellofemoral design. The question of posterior cruciate retention, sacrifice, or stabilization regarding mobile bearing designs is discussed. Current mobile bearing designs are reviewed with available technical information.