Total knee arthroplasty in rheumatoid arthritis. A comparison of the polycentric and total condylar prostheses

From 1971 to 1985, 393 total knee arthroplasties (TKAs) were performed in patients for rheumatoid arthritis. Of these, 112 used polycentric prostheses and 131 used total condylar prostheses. One hundred seven of the patients with polycentric prostheses and 102 of the patients with total condylar prostheses were followed for a minimum of two years (average, 61 and 55 months, respectively). At the time of the latest examination, nine knees with polycentric prostheses required revision surgery: six for tibial component loosening and instability and three for patellofemoral pain. Five knees with total condylar prostheses required revision: one for chronic instability, one for a late posttraumatic patellar fracture, and three for late hematogenous infections. The total condylar prostheses with patellar resurfacing had better scores for pain (8.5 points) than the polycentric prosthesis without patellofemoral resurfacing (7.0 points). The total condylar prosthesis appeared more durable in terms of fixation, with no evidence of aseptic loosening of femoral or tibial components noted in this series thus far.

Formulation of stellar speckle interferometry in terms of joint spatial/spatial-frequency representations

We propose a generalized formulation of stellar speckle interferometry (SSI) and related techniques in terms of joint spatial/spatial-frequency energy representations. We show how, within this formulation, techniques such as that of Knox-Thompson, or even standard SSI, appear to be particular implementations of a more general method. This generalized SSI is derived in a straightforward manner from the proposed joint formulation. Results from a computer simulation are presented.

An intrathoracic left ventricular assist system: utilization of results from a development program

An intrathoracic, electrohydraulically actuated, left ventricular assist system (LVAS) was subjected to formal device readiness testing. Endurance testing was initiated on eight systems before testing was halted due to failure of four of the systems. Three failed due to environmental leakage. Solutions were straightforward, involving gasket changes and o-ring resizing. The fourth failure involved a magnetic coupling piston swelling and seizing. The failure was attributed, after long investigation, to hydrogen adsorption by the samarium-cobalt magnets. An unknown number of coupling magnets were affected in this fashion, necessitating complete replacement of magnets to resolve the problem. However, this was beyond the scope of the program, and no further endurance testing was accomplished. The test experience of the Nimbus/CCF LVAS has demonstrated all functional aspects of the complete LVAS, both in vitro and in vivo, and the endurance and reliability potential is indicated as well. Although the LVAS program is currently inactive, its legacy of technical innovations continue to drive the development of other medical devices.

High-resolution imaging of the living human fovea: measurement of the intercenter cone distance by speckle interferometry

A high-resolution method that allows direct measurements of the intercenter cone distance in the living human fovea is proposed. The experimental technique is similar to that used in stellar speckle interferometry. It is based on the recording and posterior processing of coherent short-exposure images of a small area of the central fovea. By using this optical-digital procedure, we have obtained what are to our knowledge the first objective measurements in vivo of the cone spacing in the human fovea. The reconstruction of the whole spatial information of the cone mosaic would also be possible by further improvements of the technique by subsequent application of image-reconstruction algorithms.

The results of conservative management of juvenile osteochondritis dissecans using joint scintigraphy. A prospective study

A prospective clinical study used joint scintigraphy to investigate conservative treatment of juvenile osteochondritis dissecans (JOCD) of the femoral condyle. The predictive value of scintigraphic evaluation and various parameters (age at onset, sex, location and size of lesion) were analyzed. Over a 10 year period, the senior author followed 92 knees in 76 patients, 60 of whom were male and 16 female (11 and 5 bilaterals, respectively). All patients were participants in athletics or exercise programs. All patients had orthopaedic assessment, roentgenographic studies (AP, lateral, and tunnel views), 99m-Technetium phosphate compound joint scintigraphy, and instruction in a symptom-free existence (with all athletic activity proscribed). Patients were reevaluated and scanned every 8 weeks. No casts or braces were used, although crutches were sometimes necessary to maintain symptom-free levels. Based on specific indications for failure of conservative treatment, 50% of these patients failed and underwent surgery. Of the 92 knees, 52 were successfully treated conservatively, while 40 failed. Average followup was 4.2 years. Average age at onset was 12.5 years; the success group averaged 12.1 years and the failure group 13.0 years. The average lesion size was 363.2 mm2, with 309.5 mm2 in the success group and 436.0 mm2 in the failure group. Parameters of location, sex, and scan classification were not statistically significant as predictive factors. This study found no predictors for the success or failure of treatment beyond a moderate correlation of larger lesion size with failed conservative treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Study of heat dissipation to the lung from a thermal ventricular assist system

The thermally powered left ventricular assist system (LVAS) requires that heat be dissipated to surrounding lung tissue and blood. This acute study was conducted in three anesthetized calves (weighing 84.3 +/- 14.3 kg) to evaluate the mechanisms involved in the dissipation of heat to the lung tissue. The heaters were placed in contact with the left lung surface and skeletal muscle tissue. Compared to the muscle tissue, heat flux to the lung was approximately three times higher for the same surface temperatures. For a constant heat flux, lung interface temperature tended to vary inversely with the cardiac output and ventilatory flow. This preliminary study demonstrated that the level of heat generated by the thermal LVAS can be effectively dissipated to the lung, with the convection mechanisms of airflow and blood flow playing a major role.

In vitro and in vivo performance evaluation of a totally implantable electrohydraulic left ventricular assist system

The biolized electrohydraulic left ventricle assist devices were tested in 14 calves with an average survival time of 162 days and as long as 250 days without the use of anticoagulants. In vitro, the system pumped 4.1 L/min at a low 4.8 mmHg fill pressure with a mean afterload of 100 mmHg and rate of 46 bpm. A flow rate of 13.5 L/min was observed at 155 bpm and 110 mmHg afterload. Motor frequency and current increased with increasing flow rate (162 Hz, 0.67 amp at 2.5 L/min; 484 Hz, 2.43 amp at 13.5 L/min). Flow rate did not change significantly with afterload pressure. The complete system was implanted in a 100 kg calf. Synchronization of the blood pump with the natural heart was demonstrated at heart rates of 85 to 167 bpm. The synchronized flow rate varied from 6 to 10.5 L/min despite the considerable heart rate changes and stroke variations. The system hemodynamic performances were acceptable and met NIH requirements.

Development of compliance chamber diaphragms with reduced permeability

The implantable ventricular assist systems currently undergoing clinical readiness testing shuttle the displaced gas between the non-blood side of the pumping diaphragm and an elastic chamber generally called a "compliance chamber" or variable volume device. The movement of the stored gas allows the pump to fill and empty without compression or expansion of the gas behind the pump diaphragm. The material used for the construction of compliance chambers should be fatigue resistant to withstand the 63 million flexes per year of the blood pump. The material should also be biocompatible and highly impervious to gases. Significant diffusion of gases from the compliance system necessitates external make-up gases to somehow be added to the internal system. Material selection is complicated by the fact that most fatigue-resistant elastomers also have high gas permeability. In order to solve this problem, bilayer compliance chambers have been developed using biocompatible and fatigue-resistant polyolefin rubber comolded with relatively impervious butyl rubber.

Flow visualization in an artificial heart using diffuse and planar laser lighting

The purpose of the study was to characterize flow properties within a clinical pusher plate type artificial heart. Dual camera video tape and synchronized still photographs were used to study flow patterns. Diffused light and a planar laser source provided illumination. The laser light was turned into a plane of light with a thickness varying from 0.1 to 10 mm, and magnesium oxide and Amberlite particles were used as tracers. Qualitative and quantitative analyses were performed by the examination and digitization of flow patterns. Inflow, outflow, pneumatic drive and after-load pressure, diaphragm motion, cardiac output, and heart rate were measured and recorded. An electrical circuit was developed to synchronize pump diaphragm motion with captured images of flow trajectories. Trajectories were then digitized, and velocities, turbulence, and shear stresses were calculated. As the result of these experiments, disturbed, recirculating, and stagnation zones were identified and global and local turbulence values were determined. Simultaneous turbulence, stasis, recirculation, and laminar flow patterns were observed during most phases of the pumping cycle. Velocities obtained varied from 2 cm/sec to 145 cm/sec; total local shear stresses of 12 to 897 dynes/cm2 were seen.

Accommodation-dependent model of the human eye with aspherics

We consider a schematic human eye with four centered aspheric surfaces. We show that by introducing recent experimental average measurements of cornea and lens into the Gullstrand-Le Grand model, the average spherical aberration of the actual eye is predicted without any shape fitting. The chromatic dispersions are adjusted to fit the experimentally observed chromatic aberration of the eye. The polychromatic point-spread function and modulation transfer function are calculated for several pupil diameters and show good agreement with previous experimental results. Finally, from this schematic eye an accommodation-dependent model is proposed that reproduces the increment of refractive power of the eye during accommodation. The variation of asphericity with accommodation is also introduced in the model and the resulting optical performance studied.

Objective quantification method for measuring in vivo accumulated dental plaque

Dental plaque was collected, dried, and weighed on a gold insert that fit into the buccal aspect of a posterior crown. The plaque weight was determined by calculating the difference between the postcollection insert weight and the precollection insert weight. This system for measurement of the dry weight of in vivo accumulated dental plaque was found to be a practical means of plaque quantification.