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Stephen A. Mikulak, Ormonde M. Mahoney, Mylene A. delaRosa, and Thomas P. Schmalzried
- Loosening and Osteolysis with the Press-Fit Condylar Posterior-Cruciate-Substituting Total Knee Replacement
J. Bone Joint Surg. Am. 83: 398.
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OM Mahoney, and JH Dimon
- Unsatisfactory results with a ceramic total hip prosthesis
J. Bone Joint Surg. Am. 72: 663-671.
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TE Bailey, and OM Mahoney
- The use of banked autologous blood in patients undergoing surgery for spinal deformity
J. Bone Joint Surg. Am. 69: 329-332.
Abstract 1 of 3
The Journal of Bone and Joint Surgery 83:398 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.
Loosening and Osteolysis with the Press-Fit Condylar Posterior-Cruciate-Substituting Total Knee Replacement
Stephen A. Mikulak, MD,
Ormonde M. Mahoney, MD,
Mylene A. delaRosa, BS and
Thomas P. Schmalzried, MD
Investigation performed at the Joint Replacement Institute
at Orthopaedic Hospital, Los Angeles, California
Stephen A. Mikulak, MD
Ormonde M. Mahoney, MD
Mylene A. dela Rosa, BS
Thomas P. Schmalzried, MD
Joint Replacement Institute at Orthopaedic Hospital, 2400 South
Flower Street, Los Angeles, CA 90007
One or more of the authors has received or will receive benefits
for personal or professional use from a commercial party related
directly or indirectly to the subject of this article. Funds were received
in total or partial support of the research or clinical study presented
in this article. The funding source was the Los Angeles Orthopaedic
Foundation.
Background: Aseptic loosening and osteolysis
are rarely associated with cemented posterior-cruciate-substituting total
knee replacements. Consequently, there is a paucity of information
on this topic.
Methods: After a mean follow-up interval of fifty-six
months (range, thirty-seven to eighty-nine months), sixteen (2.9%)
of 557 posterior-cruciate-substituting primary total knee replacements
were revised by a single surgeon because of loosening and osteolysis. Clinical,
radiographic, and retrieval analyses were conducted to determine
the mechanism of loosening and to identify associated risk factors.
Results: All sixteen knees (fifteen patients) were
rated as good or excellent at one year after the primary replacement,
with mean clinical and functional Knee Society scores of 95 and
86 points, respectively. Nine of the fifteen patients who had a
revision because of loosening and osteolysis had had a total knee
arthroplasty on the contralateral side compared with only 18% of
the patients who did not have a revision (p = 0.026). No
evidence of transmission of substantial anteroposterior stresses from
the posterior-cruciate-substituting mechanism was found. All twelve
retrieved knee implants, however, had damage to the lateral and medial
side walls of the polyethylene posterior-cruciate-substituting post.
Damage to the inferior surface of the polyethylene inserts had a
rotational pattern, with the axis of rotation in the medial compartment.
Surface damage in a rotational pattern was also present on the superior
and inferior surfaces of the titanium tibial base-plates.
Conclusions: In the knees in our study, rotational
forces were generated by impingement of the side walls of the intercondylar
box on the polyethylene post. Such box-post impingement can occur
throughout the range of motion. Rotational stresses are transmitted to
the modular interfaces and to the metal-cement interfaces, resulting
in loosening and osteolysis. A reduction in rotational constraint
would be desirable. Patients with bilateral total knee replacement may
be at increased risk for this type of loosening.
[Full Text of Mikulak et al.]
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Abstract 2 of 3
The Journal of Bone and Joint Surgery, Vol 72, Issue 5 663-671, Copyright © 1990 by Journal of Bone and Joint Surgery, Inc
Unsatisfactory results with a ceramic total hip prosthesis
OM Mahoney and JH Dimon
Peachtree Orthopaedic Clinic, Piedmont Hospital, Atlanta, Georgia 30367.
We reviewed the results of forty-two total hip replacements that had been
done with the self-locking Autophor ceramic total hip prosthesis in
thirty-four patients. The patients ranged in age from twenty-five to
sixty-seven years (average, forty-eight years). The diagnoses were
avascular necrosis (eight patients), degenerative arthritis (nineteen
patients), ankylosing spondylitis (one patient), post-traumatic arthritis
(two patients), and rheumatoid arthritis (four patients). Seven procedures
were revisions: five, of a loose cemented total hip prosthesis and two, of
a loose noncemented endoprosthesis. No revision was done for infection. The
length of follow-up ranged from twenty-seven to sixty-six months (average,
fifty-one months). The patients were evaluated by physical examination,
serial radiographs, and questionnaires. The hips were rated with the
modified Harris hip score. At the time of follow-up, eleven of the
twenty-seven patients who had had a primary hip replacement complained of
at least moderate pain that limited activities; however, only three
patients had to have a revision. The femoral components had a notable
tendency to subside more than five millimeters, and in fifteen hips there
was radiographic evidence of progressive loosening. Our experience with the
self-locking Autophor ceramic total hip prosthesis has been disappointing.
We no longer use it.
[Reprint (PDF) Version of Mahoney and Dimon]
Abstract 3 of 3
The Journal of Bone and Joint Surgery, Vol 69, Issue 3 329-332, Copyright © 1987 by Journal of Bone and Joint Surgery, Inc
The use of banked autologous blood in patients undergoing surgery for spinal deformity
TE Bailey and OM Mahoney
The cases of fifty-two patients who underwent sixty elective spinal fusions
for spinal deformity were studied to evaluate the efficacy of the use of
banked autologous blood to replace operative loss of blood. The patients
ranged in age from ten to forty-nine years. Each patient began to take 325
milligrams of ferrous sulphate, three times a day, as soon as surgery was
scheduled, and was evaluated weekly at the Shepeard Community Blood Bank.
If a patient's hemoglobin level was more than eleven milligrams per 100
milliliters, either a whole unit of blood or a half-unit was drawn at each
visit. An average of 3.3 units of blood (range, 1.5 to 6.0 units) was
obtained and was stored for as long as forty-two days. Either citrate
phosphate dextrose with adenine (CPDA-1) or adenine, dextrose, and mannitol
(ADSOL) was used as a preservative. In 85 per cent of the procedures only
autologous blood was required for transfusion. This method proved to be
simple, safe, and very well accepted.
[Reprint (PDF) Version of Bailey and Mahoney]
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