Richard Balderston - Academia.edu (original) (raw)

Papers by Richard Balderston

Rothman Simeone The Spine, 2011

The Journal of Bone and Joint Surgery, Apr 1, 1997

J Arthroplasty, 1986

Three hundred forty-one consecutive Charnley total hip arthroplasties were reviewed after a 3-10-... more Three hundred forty-one consecutive Charnley total hip arthroplasties were reviewed after a 3-10-year follow-up period to correlate the radiographic signs of aseptic loosening to clinical outcome, femoral cementing technique, and epidemiologic patient characteristics. High-grade femoral demarcation at the bone-cement interface (75-100%) correlated with a significantly higher incidence of unsatisfactory follow-up clinical scores. The incidence of high-grade femoral bone-cement demarcation and the associated radiographic signs of aseptic loosening had a direct correlation with the quality of the femoral cementing technique (P less than .01). Trochanter nonunion or trochanter separation demonstrated a highly significant correlation with high-grade femoral bone-cement demarcation (P less than .001). Patients having secondary total hip arthroplasty for failed cup arthroplasty or endoprosthesis had a higher rate of unsatisfactory pain and function scores, compared with those having arthroplasties performed after failed internal fixation. Male patients or patients with a high activity level demonstrated a twofold greater incidence of high-grade femoral demarcation (P less than .05). Patient weight by itself did not demonstrate any effect on radiographic outcome.

Clinical Orthopaedics and Related Research, Mar 1, 1993

Cemented total hip arthroplasties (THAs) were performed through a Charnley transtrochanteric appr... more Cemented total hip arthroplasties (THAs) were performed through a Charnley transtrochanteric approach in 1162 patients from 1970 through 1986. Trochanteric separations numbered 58 (5%). Rate of nonunion was related to gender, preoperative diagnosis, and prior THA or endoprosthesis. Nonunion patients had lower mean Charnley pain and function mean scores than union patients at the 45- and 49-month examinations, respectively. A Trendelenberg gait was noted in 17% of nonunions compared with 6% of united patients. Revision rates were nearly three times higher in nonunion patients. These results indicate there is a quantifiable risk for a surgeon who chooses to use a trochanteric osteotomy.

Operative Techniques in Orthopaedics, 1993

The transthoracic approach to the vertebral bodies offers the widest exposure of the anterior tho... more The transthoracic approach to the vertebral bodies offers the widest exposure of the anterior thoracic spine for decompression and strut graft reconstruction. The standard approach exposes T4 to T12 and modifications extend the exposure to the extreme upper thoracic and thoracolumbar junctions. Surgeons unfamiliar with this relatively uncommon approach must be thoroughly aware of its indications, preoperative evaluation, surgical technique, and potential complications before attempting it. This review details the methods we believe best limit the complications associated with transthoracic corpectomy and strut fusion.

Spine, Oct 1, 1991

Fifty-nine patients were identified with 70 gastrointestinal tract complications from a review of... more Fifty-nine patients were identified with 70 gastrointestinal tract complications from a review of 950 spinal cord injury patients admitted during a 10-year period (prevalence 6.2%). When compared to a random spinal-cord-injured noncomplication control group (N = 31 patients), there was no difference in the percentage of low-dose steroids (dexamethasone 40 mg/day) given or in the percentage of patients receiving ulcer prophylaxis. All but two patients in the complication group received ulcer prophylaxis. Although an increase in the percentage of cervical and complete lesions was seen in the bleeding complications group, this increase was not statistically significant. The low complication rate (6.2%) seen in this study probably reflects the global use of ulcer prophylaxis and heightened awareness at a regional spinal cord injury center.

Clinical Orthopaedics and Related Research, Feb 1, 1997

Anterior cervical plate instrumentation is useful in the maintenance of cervical alignment, the p... more Anterior cervical plate instrumentation is useful in the maintenance of cervical alignment, the prevention of graft extrusion, and the development of late deformity as well as potentially avoiding the need for a secondary posterior cervical procedure in the setting of cervical trauma. Its role in cervical reconstruction after decompression for cervical spondylosis is evolving. The definite risks of anterior cervical instrumentation should be considered, that is, screw and plate displacement or screw violation of neurologic structures, before the implementation of this form of fixation.

Spine, 1998

The authors of this prospective study examined the preoperative and 3-year postoperative magnetic... more The authors of this prospective study examined the preoperative and 3-year postoperative magnetic resonance images of 14 patients undergoing anterior and posterior fusion and/or posterior fusion only for scoliosis. All magnetic resonance images were ready by two independent neuroradiologists, who were blinded to the purposes of the study, for the presence of disc narrowing, signal decrease on T2, or herniated nucleus pulposus before and after surgery. Particular attention was paid to the disc changes at the level directly below the end vertebral level of the fusion and two levels below the fusion in the lumbosacral spine existing before surgical intervention. To evaluate the potential for disc degeneration distal to long scoliosis fusions with end fusion levels in the mid to lower lumbar spine. The determination of end levels of fusion for contructs presently used to manage adult scoliotic deformity has been evaluated in terms of correction of curvature and late decompensation in co...

Spine, 1986

This paper is a review of current information on cervical radiculopathy. The focus is on the natu... more This paper is a review of current information on cervical radiculopathy. The focus is on the natural history of the process, the accuracy of diagnostic tests to determine etiology, the differential diagnosis involved, and the surgical tactics available. The most important conclusions are the criteria for patient selection for surgery and a statistical demonstration of the adequacy of both the anterior and the posterior approaches for decompression of the cervical nerve root.

Journal of spinal disorders, 1988

Twenty patients with sciatica associated with anomalous lumbar nerve roots were reviewed with an ... more Twenty patients with sciatica associated with anomalous lumbar nerve roots were reviewed with an average follow-up of 26.3 months. All patients had predominantly leg pain and their nerve root anomaly was known preoperatively. Overall success rate was 65% but was increased to 80% in patients with concurrent disk herniation. Improved results of surgical decompression were most consistently associated with concurrent disk herniation whereas other factors such as more extensive decompression were less strongly correlated. Surgery should only be offered with these results in mind.

Spine, 1995

Fifty-five patients undergoing surgery for adult spinal deformity assessed their health status us... more Fifty-five patients undergoing surgery for adult spinal deformity assessed their health status using a generic health outcome instrument before surgery and at an average of 2 years after surgery. To assess whether adult spinal deformity surgery is a useful intervention when patients evaluate their own perception of health. The Medical Outcomes Survey Short Form-36, a validated generic health outcome assessment form, was used to measure patient's health status. Surgery for adult scoliosis is technically demanding. No study that we are aware of uses a generic health outcome instrument in a prospective manner to compare patients' perception of their health after adult scoliosis surgery. The Medical Outcomes Survey Short Form-36 has been validated in multiple studies assessing other medical conditions and was found to be reliable, comprehensive, brief, and generic. Sixty-eight adult patients undergoing surgery for adult spinal deformity were prospectively enrolled. Fifty-five patients were available to complete the Medical Outcomes Surgery Short Form-36 after surgery. The scores of the health profile were compared before and after surgery. The results of patients younger than 40 years were compared with those of patients older than 40 years. The results of patients younger than 40 years were compared with those of patients older than 40 years. The results of patients fused to more caudal end vertebral levels ((L4, L5)5) were compared with those who were fused to more cranial end vertebral levels. The results of patients without complications after surgery were compared with those of patients with complications after surgery. Average follow-up period was 22.5 months (minimum 12 months) in 82% of 68 patients. Statistically significant improvements were seen in postoperative scores for physical function, social function, bodily pain, and perceived health change. We found no significant differences in self-reported health function parameters related to age ( > 40 vs. < 40), end vertebral level of fusion, or presence of complications after surgery. Applying a generic health outcome instrument to adult spinal deformity surgery shows that adult scoliosis surgery significantly improves patient self-reported health assessment and function. Beneficial results do not appear to deteriorate with age or more caudal end vertebral levels of fusion. Future studies combining disease-specific outcomes analysis and generic health surveys to assess end results of adult spinal deformity surgery will be useful.

Spine, 1986

This study is a retrospective review of 43 adult patients with idiopathic or congenital scoliosis... more This study is a retrospective review of 43 adult patients with idiopathic or congenital scoliosis who had spinal fusion from T11 or above to the sacrum. This study was prompted by the frustrations of the treating surgeons in attempting long fusions from the thoracic spine to the sacrum. Of 25 patients treated with a single-stage posterior fusion only 28% had a good result with a single procedure. Failures were due to pseudarthrosis, decompensation, or loss of lumbar lordosis. Ten patients treated with posterior fusion and subsequent 6-month augmentation had a 70% success rate. Eight patients treated with anterior followed by posterior fusion had a 75% success rate. The ideal answer to this clinical problem has not yet been found.

Spine, 1993

The use of autologous blood is a well established and extremely popular technique to decrease the... more The use of autologous blood is a well established and extremely popular technique to decrease the necessity for homologous transfusions and the attendant risks of hepatitis, HIV, and HTLV--I/II infections. The most beneficial timing for autologous reinfusion of predonated blood remains unknown. The present study was undertaken to determine the optimal timing of autologous blood reinfusion in elective spinal surgery. Fifty-seven patients were prospectively individually randomly allocated into early versus delayed reinfusion groups prior to undergoing elective spinal surgery by a single surgeon. Three surgical subgroups were entered into the study: anterior/posterior (A/P) spinal fusion patients, posterior thoracolumbar scoliosis fusion patients (PSF), and degenerative posterior lumbar fusion patients (LF). Randomization was successful in that three was no significant difference in male to female ratio, age, preoperative hemoglobin, or number of units predonated between the early and delayed reinfusion groups. Likewise, there was no significant difference in the details of the operative procedure when compared as a group for the early versus delayed reinfusion groups. A significant increase in the postoperative day #1, 2 and 3 hemoglobin was seen in the early reinfusion group, while there was no significant difference seen in the postoperative day #7 hemoglobin between the early versus delayed reinfusion group. There was no effect of surgical grouping on these significant comparisons. Earlier patient mobilization was also seen in the early reinfusion groups for the A/P and PSF groups. There was no difference in patients' subjective evaluation of satisfaction and discomfort between the early or delayed reinfusion groups as determined by blinded interview on days 1, 3, 5, and 7 postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Journal of Orthopaedic Trauma, 1990

The incidence of acute herniated nucleus pulposus was determined in 55 patients with cervical spi... more The incidence of acute herniated nucleus pulposus was determined in 55 patients with cervical spine trauma. A standardized protocol and a 1.5-T magnetic resonance image scanner was used to document a 42% incidence of acute herniated nucleus pulposus in patients studied within 72 hours of injury. The incidence of herniated nucleus pulposus was correlated with the patients' presenting neurologic status and mechanism of injury. The incidence of herniated nucleus pulposus was highest in patients with bilateral facet dislocations (80%) and anterior cord syndromes (100%). There was no statistically significant correlation between the incidence of herniated nucleus pulposus and patients' age or sex.

The Journal of Arthroplasty, 1986

Three hundred forty-one consecutive Charnley total hip arthroplasties were reviewed after a 3-10-... more Three hundred forty-one consecutive Charnley total hip arthroplasties were reviewed after a 3-10-year follow-up period to correlate the radiographic signs of aseptic loosening to clinical outcome, femoral cementing technique, and epidemiologic patient characteristics. High-grade femoral demarcation at the bone-cement interface (75-100%) correlated with a significantly higher incidence of unsatisfactory follow-up clinical scores. The incidence of high-grade femoral bone-cement demarcation and the associated radiographic signs of aseptic loosening had a direct correlation with the quality of the femoral cementing technique (P less than .01). Trochanter nonunion or trochanter separation demonstrated a highly significant correlation with high-grade femoral bone-cement demarcation (P less than .001). Patients having secondary total hip arthroplasty for failed cup arthroplasty or endoprosthesis had a higher rate of unsatisfactory pain and function scores, compared with those having arthroplasties performed after failed internal fixation. Male patients or patients with a high activity level demonstrated a twofold greater incidence of high-grade femoral demarcation (P less than .05). Patient weight by itself did not demonstrate any effect on radiographic outcome.

Clinical Orthopaedics and Related Research, 1993

One hundred patients had total hip arthroplasty (THA) with either a modified Hardinge approach or... more One hundred patients had total hip arthroplasty (THA) with either a modified Hardinge approach or transtrochanteric lateral approach. Perioperative data showed that osteotomies resulted in significantly more blood loss but required shorter operative time. Postoperative pain, using a visual analog scale, showed no statistical difference between the two groups. Postoperative hip scores for pain, function, and range of motion (ROM), presence of limp, and abductor muscle strength scores showed no significant difference between groups at six months and one year. Roentgenographic follow-up evaluation showed a mean acetabular cup angle of 40 degrees and a neutral-to-valgus femoral stem position in all patients. Trochanteric union was present in 92%. Heterotopic ossification occurred predominantly in the Hardinge patients but was not functionally significant. Therefore, the ability to achieve adequate pain relief and function with THA is not affected by the type of approach.

Clinical Orthopaedics and Related Research, 1993

Cemented total hip arthroplasties (THAs) were performed through a Charnley transtrochanteric appr... more Cemented total hip arthroplasties (THAs) were performed through a Charnley transtrochanteric approach in 1162 patients from 1970 through 1986. Trochanteric separations numbered 58 (5%). Rate of nonunion was related to gender, preoperative diagnosis, and prior THA or endoprosthesis. Nonunion patients had lower mean Charnley pain and function mean scores than union patients at the 45- and 49-month examinations, respectively. A Trendelenberg gait was noted in 17% of nonunions compared with 6% of united patients. Revision rates were nearly three times higher in nonunion patients. These results indicate there is a quantifiable risk for a surgeon who chooses to use a trochanteric osteotomy.

The Journal of Arthroplasty, Dec 1, 1992

During a 5 1/2-year period from January 1984 to July 1989, 736 patients between the ages of 50 an... more During a 5 1/2-year period from January 1984 to July 1989, 736 patients between the ages of 50 and 75 with a diagnosis of osteoarthritis had either cemented or uncemented primary total hip arthroplasty. Patients were treated with low-dose sodium warfarin for prophylaxis against pulmonary embolism and had preoperative and postoperative serial lung scanning. The overall incidence of pulmonary embolism was not statistically different between the cemented and uncemented groups (3.87% and 6.19%, respectively; P > .05). Eighty-one percent of the pulmonary emboli were asymptomatic. The incidence of pulmonary embolism was higher in men than in women (7.3% and 2.93%, respectively; P < .05) but did not differ within each individual sex for the cemented and uncemented groups. Of greater significance, when the two initial groups were matched to control for sex and weight differences (564 patients), the incidence of pulmonary embolism narrowed to 4.3% and 5.3% in the cemented and uncemented groups, respectively (P > .55). These data indicate that the use of uncemented total hip arthroplasty does not offer any additional protective value against pulmonary embolism when using low-dose sodium warfarin prophylaxis.

Clinical Orthopaedics and Related Research, Apr 1, 1993

Seventy-one cemented total hip arthroplasties (THAs) in 66 patients were compared with 70 cementl... more Seventy-one cemented total hip arthroplasties (THAs) in 66 patients were compared with 70 cementless THAs in 61 patients. The cemented and cementless components were identical except for the presence of a porous proximal surface on the cementless component. The mean follow-up time was 4.3 years in the cemented group and 4.1 years in the cementless group, with a minimum follow-up of two years. Postoperative Charnley pain scores were identical for both groups, as was the incidence of limp. The final Charnley function score, however was significantly higher in the cementless group (5.6) than in the cemented group (5.1). One revision was performed in the cemented group, none in the cementless group. Complete demarcation of the bone-cement interface was presented in two cemented components and was associated with subsidence. Three cementless components had early subsidence, and two of these had complete radiopaque lines around the porous surface. None of these three patients, however, had unsatisfactory pain or function scores. The most important finding of this study is the equivalence of clinical results noted in both cemented and cementless THA as late as six years after operation.

Rothman Simeone The Spine, 2011

The Journal of Bone and Joint Surgery, Apr 1, 1997

J Arthroplasty, 1986

Three hundred forty-one consecutive Charnley total hip arthroplasties were reviewed after a 3-10-... more Three hundred forty-one consecutive Charnley total hip arthroplasties were reviewed after a 3-10-year follow-up period to correlate the radiographic signs of aseptic loosening to clinical outcome, femoral cementing technique, and epidemiologic patient characteristics. High-grade femoral demarcation at the bone-cement interface (75-100%) correlated with a significantly higher incidence of unsatisfactory follow-up clinical scores. The incidence of high-grade femoral bone-cement demarcation and the associated radiographic signs of aseptic loosening had a direct correlation with the quality of the femoral cementing technique (P less than .01). Trochanter nonunion or trochanter separation demonstrated a highly significant correlation with high-grade femoral bone-cement demarcation (P less than .001). Patients having secondary total hip arthroplasty for failed cup arthroplasty or endoprosthesis had a higher rate of unsatisfactory pain and function scores, compared with those having arthroplasties performed after failed internal fixation. Male patients or patients with a high activity level demonstrated a twofold greater incidence of high-grade femoral demarcation (P less than .05). Patient weight by itself did not demonstrate any effect on radiographic outcome.

Clinical Orthopaedics and Related Research, Mar 1, 1993

Cemented total hip arthroplasties (THAs) were performed through a Charnley transtrochanteric appr... more Cemented total hip arthroplasties (THAs) were performed through a Charnley transtrochanteric approach in 1162 patients from 1970 through 1986. Trochanteric separations numbered 58 (5%). Rate of nonunion was related to gender, preoperative diagnosis, and prior THA or endoprosthesis. Nonunion patients had lower mean Charnley pain and function mean scores than union patients at the 45- and 49-month examinations, respectively. A Trendelenberg gait was noted in 17% of nonunions compared with 6% of united patients. Revision rates were nearly three times higher in nonunion patients. These results indicate there is a quantifiable risk for a surgeon who chooses to use a trochanteric osteotomy.

Operative Techniques in Orthopaedics, 1993

The transthoracic approach to the vertebral bodies offers the widest exposure of the anterior tho... more The transthoracic approach to the vertebral bodies offers the widest exposure of the anterior thoracic spine for decompression and strut graft reconstruction. The standard approach exposes T4 to T12 and modifications extend the exposure to the extreme upper thoracic and thoracolumbar junctions. Surgeons unfamiliar with this relatively uncommon approach must be thoroughly aware of its indications, preoperative evaluation, surgical technique, and potential complications before attempting it. This review details the methods we believe best limit the complications associated with transthoracic corpectomy and strut fusion.

Spine, Oct 1, 1991

Fifty-nine patients were identified with 70 gastrointestinal tract complications from a review of... more Fifty-nine patients were identified with 70 gastrointestinal tract complications from a review of 950 spinal cord injury patients admitted during a 10-year period (prevalence 6.2%). When compared to a random spinal-cord-injured noncomplication control group (N = 31 patients), there was no difference in the percentage of low-dose steroids (dexamethasone 40 mg/day) given or in the percentage of patients receiving ulcer prophylaxis. All but two patients in the complication group received ulcer prophylaxis. Although an increase in the percentage of cervical and complete lesions was seen in the bleeding complications group, this increase was not statistically significant. The low complication rate (6.2%) seen in this study probably reflects the global use of ulcer prophylaxis and heightened awareness at a regional spinal cord injury center.

Clinical Orthopaedics and Related Research, Feb 1, 1997

Anterior cervical plate instrumentation is useful in the maintenance of cervical alignment, the p... more Anterior cervical plate instrumentation is useful in the maintenance of cervical alignment, the prevention of graft extrusion, and the development of late deformity as well as potentially avoiding the need for a secondary posterior cervical procedure in the setting of cervical trauma. Its role in cervical reconstruction after decompression for cervical spondylosis is evolving. The definite risks of anterior cervical instrumentation should be considered, that is, screw and plate displacement or screw violation of neurologic structures, before the implementation of this form of fixation.

Spine, 1998

The authors of this prospective study examined the preoperative and 3-year postoperative magnetic... more The authors of this prospective study examined the preoperative and 3-year postoperative magnetic resonance images of 14 patients undergoing anterior and posterior fusion and/or posterior fusion only for scoliosis. All magnetic resonance images were ready by two independent neuroradiologists, who were blinded to the purposes of the study, for the presence of disc narrowing, signal decrease on T2, or herniated nucleus pulposus before and after surgery. Particular attention was paid to the disc changes at the level directly below the end vertebral level of the fusion and two levels below the fusion in the lumbosacral spine existing before surgical intervention. To evaluate the potential for disc degeneration distal to long scoliosis fusions with end fusion levels in the mid to lower lumbar spine. The determination of end levels of fusion for contructs presently used to manage adult scoliotic deformity has been evaluated in terms of correction of curvature and late decompensation in co...

Spine, 1986

This paper is a review of current information on cervical radiculopathy. The focus is on the natu... more This paper is a review of current information on cervical radiculopathy. The focus is on the natural history of the process, the accuracy of diagnostic tests to determine etiology, the differential diagnosis involved, and the surgical tactics available. The most important conclusions are the criteria for patient selection for surgery and a statistical demonstration of the adequacy of both the anterior and the posterior approaches for decompression of the cervical nerve root.

Journal of spinal disorders, 1988

Twenty patients with sciatica associated with anomalous lumbar nerve roots were reviewed with an ... more Twenty patients with sciatica associated with anomalous lumbar nerve roots were reviewed with an average follow-up of 26.3 months. All patients had predominantly leg pain and their nerve root anomaly was known preoperatively. Overall success rate was 65% but was increased to 80% in patients with concurrent disk herniation. Improved results of surgical decompression were most consistently associated with concurrent disk herniation whereas other factors such as more extensive decompression were less strongly correlated. Surgery should only be offered with these results in mind.

Spine, 1995

Fifty-five patients undergoing surgery for adult spinal deformity assessed their health status us... more Fifty-five patients undergoing surgery for adult spinal deformity assessed their health status using a generic health outcome instrument before surgery and at an average of 2 years after surgery. To assess whether adult spinal deformity surgery is a useful intervention when patients evaluate their own perception of health. The Medical Outcomes Survey Short Form-36, a validated generic health outcome assessment form, was used to measure patient's health status. Surgery for adult scoliosis is technically demanding. No study that we are aware of uses a generic health outcome instrument in a prospective manner to compare patients' perception of their health after adult scoliosis surgery. The Medical Outcomes Survey Short Form-36 has been validated in multiple studies assessing other medical conditions and was found to be reliable, comprehensive, brief, and generic. Sixty-eight adult patients undergoing surgery for adult spinal deformity were prospectively enrolled. Fifty-five patients were available to complete the Medical Outcomes Surgery Short Form-36 after surgery. The scores of the health profile were compared before and after surgery. The results of patients younger than 40 years were compared with those of patients older than 40 years. The results of patients younger than 40 years were compared with those of patients older than 40 years. The results of patients fused to more caudal end vertebral levels ((L4, L5)5) were compared with those who were fused to more cranial end vertebral levels. The results of patients without complications after surgery were compared with those of patients with complications after surgery. Average follow-up period was 22.5 months (minimum 12 months) in 82% of 68 patients. Statistically significant improvements were seen in postoperative scores for physical function, social function, bodily pain, and perceived health change. We found no significant differences in self-reported health function parameters related to age ( > 40 vs. < 40), end vertebral level of fusion, or presence of complications after surgery. Applying a generic health outcome instrument to adult spinal deformity surgery shows that adult scoliosis surgery significantly improves patient self-reported health assessment and function. Beneficial results do not appear to deteriorate with age or more caudal end vertebral levels of fusion. Future studies combining disease-specific outcomes analysis and generic health surveys to assess end results of adult spinal deformity surgery will be useful.

Spine, 1986

This study is a retrospective review of 43 adult patients with idiopathic or congenital scoliosis... more This study is a retrospective review of 43 adult patients with idiopathic or congenital scoliosis who had spinal fusion from T11 or above to the sacrum. This study was prompted by the frustrations of the treating surgeons in attempting long fusions from the thoracic spine to the sacrum. Of 25 patients treated with a single-stage posterior fusion only 28% had a good result with a single procedure. Failures were due to pseudarthrosis, decompensation, or loss of lumbar lordosis. Ten patients treated with posterior fusion and subsequent 6-month augmentation had a 70% success rate. Eight patients treated with anterior followed by posterior fusion had a 75% success rate. The ideal answer to this clinical problem has not yet been found.

Spine, 1993

The use of autologous blood is a well established and extremely popular technique to decrease the... more The use of autologous blood is a well established and extremely popular technique to decrease the necessity for homologous transfusions and the attendant risks of hepatitis, HIV, and HTLV--I/II infections. The most beneficial timing for autologous reinfusion of predonated blood remains unknown. The present study was undertaken to determine the optimal timing of autologous blood reinfusion in elective spinal surgery. Fifty-seven patients were prospectively individually randomly allocated into early versus delayed reinfusion groups prior to undergoing elective spinal surgery by a single surgeon. Three surgical subgroups were entered into the study: anterior/posterior (A/P) spinal fusion patients, posterior thoracolumbar scoliosis fusion patients (PSF), and degenerative posterior lumbar fusion patients (LF). Randomization was successful in that three was no significant difference in male to female ratio, age, preoperative hemoglobin, or number of units predonated between the early and delayed reinfusion groups. Likewise, there was no significant difference in the details of the operative procedure when compared as a group for the early versus delayed reinfusion groups. A significant increase in the postoperative day #1, 2 and 3 hemoglobin was seen in the early reinfusion group, while there was no significant difference seen in the postoperative day #7 hemoglobin between the early versus delayed reinfusion group. There was no effect of surgical grouping on these significant comparisons. Earlier patient mobilization was also seen in the early reinfusion groups for the A/P and PSF groups. There was no difference in patients' subjective evaluation of satisfaction and discomfort between the early or delayed reinfusion groups as determined by blinded interview on days 1, 3, 5, and 7 postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Journal of Orthopaedic Trauma, 1990

The incidence of acute herniated nucleus pulposus was determined in 55 patients with cervical spi... more The incidence of acute herniated nucleus pulposus was determined in 55 patients with cervical spine trauma. A standardized protocol and a 1.5-T magnetic resonance image scanner was used to document a 42% incidence of acute herniated nucleus pulposus in patients studied within 72 hours of injury. The incidence of herniated nucleus pulposus was correlated with the patients' presenting neurologic status and mechanism of injury. The incidence of herniated nucleus pulposus was highest in patients with bilateral facet dislocations (80%) and anterior cord syndromes (100%). There was no statistically significant correlation between the incidence of herniated nucleus pulposus and patients' age or sex.

The Journal of Arthroplasty, 1986

Three hundred forty-one consecutive Charnley total hip arthroplasties were reviewed after a 3-10-... more Three hundred forty-one consecutive Charnley total hip arthroplasties were reviewed after a 3-10-year follow-up period to correlate the radiographic signs of aseptic loosening to clinical outcome, femoral cementing technique, and epidemiologic patient characteristics. High-grade femoral demarcation at the bone-cement interface (75-100%) correlated with a significantly higher incidence of unsatisfactory follow-up clinical scores. The incidence of high-grade femoral bone-cement demarcation and the associated radiographic signs of aseptic loosening had a direct correlation with the quality of the femoral cementing technique (P less than .01). Trochanter nonunion or trochanter separation demonstrated a highly significant correlation with high-grade femoral bone-cement demarcation (P less than .001). Patients having secondary total hip arthroplasty for failed cup arthroplasty or endoprosthesis had a higher rate of unsatisfactory pain and function scores, compared with those having arthroplasties performed after failed internal fixation. Male patients or patients with a high activity level demonstrated a twofold greater incidence of high-grade femoral demarcation (P less than .05). Patient weight by itself did not demonstrate any effect on radiographic outcome.

Clinical Orthopaedics and Related Research, 1993

One hundred patients had total hip arthroplasty (THA) with either a modified Hardinge approach or... more One hundred patients had total hip arthroplasty (THA) with either a modified Hardinge approach or transtrochanteric lateral approach. Perioperative data showed that osteotomies resulted in significantly more blood loss but required shorter operative time. Postoperative pain, using a visual analog scale, showed no statistical difference between the two groups. Postoperative hip scores for pain, function, and range of motion (ROM), presence of limp, and abductor muscle strength scores showed no significant difference between groups at six months and one year. Roentgenographic follow-up evaluation showed a mean acetabular cup angle of 40 degrees and a neutral-to-valgus femoral stem position in all patients. Trochanteric union was present in 92%. Heterotopic ossification occurred predominantly in the Hardinge patients but was not functionally significant. Therefore, the ability to achieve adequate pain relief and function with THA is not affected by the type of approach.

Clinical Orthopaedics and Related Research, 1993

Cemented total hip arthroplasties (THAs) were performed through a Charnley transtrochanteric appr... more Cemented total hip arthroplasties (THAs) were performed through a Charnley transtrochanteric approach in 1162 patients from 1970 through 1986. Trochanteric separations numbered 58 (5%). Rate of nonunion was related to gender, preoperative diagnosis, and prior THA or endoprosthesis. Nonunion patients had lower mean Charnley pain and function mean scores than union patients at the 45- and 49-month examinations, respectively. A Trendelenberg gait was noted in 17% of nonunions compared with 6% of united patients. Revision rates were nearly three times higher in nonunion patients. These results indicate there is a quantifiable risk for a surgeon who chooses to use a trochanteric osteotomy.

The Journal of Arthroplasty, Dec 1, 1992

During a 5 1/2-year period from January 1984 to July 1989, 736 patients between the ages of 50 an... more During a 5 1/2-year period from January 1984 to July 1989, 736 patients between the ages of 50 and 75 with a diagnosis of osteoarthritis had either cemented or uncemented primary total hip arthroplasty. Patients were treated with low-dose sodium warfarin for prophylaxis against pulmonary embolism and had preoperative and postoperative serial lung scanning. The overall incidence of pulmonary embolism was not statistically different between the cemented and uncemented groups (3.87% and 6.19%, respectively; P > .05). Eighty-one percent of the pulmonary emboli were asymptomatic. The incidence of pulmonary embolism was higher in men than in women (7.3% and 2.93%, respectively; P < .05) but did not differ within each individual sex for the cemented and uncemented groups. Of greater significance, when the two initial groups were matched to control for sex and weight differences (564 patients), the incidence of pulmonary embolism narrowed to 4.3% and 5.3% in the cemented and uncemented groups, respectively (P > .55). These data indicate that the use of uncemented total hip arthroplasty does not offer any additional protective value against pulmonary embolism when using low-dose sodium warfarin prophylaxis.

Clinical Orthopaedics and Related Research, Apr 1, 1993

Seventy-one cemented total hip arthroplasties (THAs) in 66 patients were compared with 70 cementl... more Seventy-one cemented total hip arthroplasties (THAs) in 66 patients were compared with 70 cementless THAs in 61 patients. The cemented and cementless components were identical except for the presence of a porous proximal surface on the cementless component. The mean follow-up time was 4.3 years in the cemented group and 4.1 years in the cementless group, with a minimum follow-up of two years. Postoperative Charnley pain scores were identical for both groups, as was the incidence of limp. The final Charnley function score, however was significantly higher in the cementless group (5.6) than in the cemented group (5.1). One revision was performed in the cemented group, none in the cementless group. Complete demarcation of the bone-cement interface was presented in two cemented components and was associated with subsidence. Three cementless components had early subsidence, and two of these had complete radiopaque lines around the porous surface. None of these three patients, however, had unsatisfactory pain or function scores. The most important finding of this study is the equivalence of clinical results noted in both cemented and cementless THA as late as six years after operation.