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New Philadelphia, PA, United States

A thorough consideration of all factors contributing to successful dialysis access creation is necessary to achieve optimal outcomes. A high bifurcation of the brachial artery (brachioradial variant) occurs in greater than 20% of patients. Dialysis access was created in 22 limbs with this variant-15 fistula, and 7 prosthetic grafts. Nonmaturation occurred in 33% of fistula. Early thromboses occurred in 29% of prosthetic bridge grafts. In this experience, the brachioradial variant is associated with a relatively higher rate of fistula nonmaturation and prosthetic graft thromboses. These findings reinforce the critical role of preoperative imaging studies in dialysis access creation. A sound algorithm for the surgical management of the brachioradial variation facilitates decision making and will improve dialysis access outcomes. © 2011 Wiley Periodicals, Inc. Source

Namdari S.,Washington University in St. Louis | Melnic C.,University of Pennsylvania | Huffman G.R.,Penn Presbyterian Medical Center
Clinical Orthopaedics and Related Research

Background: Biologic glenoid resurfacing is a treatment option for young patients with glenohumeral arthritis. An optimal synthetic graft for glenoid resurfacing should allow repopulation with host cells, be durable enough to tolerate suture fixation and forces across the joint, and present no host inflammatory response. We report two cases of giant cell reaction to GraftJacket® after biologic glenoid resurfacing. Case Description: Two patients who underwent hemiarthroplasty and biologic glenoid resurfacing using GraftJacket® had a foreign body giant cell reaction that required revision surgery. Intraoperatively, both patients were observed to have a well-fixed humeral component and a dense, erythematous, synovitic membrane overlying the glenoid. Pathology specimens showed a benign reactive synovium, chronic inflammation, and foreign body giant cell reaction. After débridement and conversion to total shoulder arthroplasty, both patients continued to be pain-free at greater than 1-year followup. Literature Review: Multinucleated giant cell and mononuclear cell responses have been observed in an animal model after use of GraftJacket®. Although the use of acellular matrix-based scaffold for biologic glenoid resurfacing is not new, the possibility of foreign body reaction as a source of persistent symptoms has not been described. Clinical Relevance: Given the lack of data to indicate an advantage to biologic resurfacing of the glenoid over hemiarthroplasty alone, resurfacing should not introduce significant additional surgical complications. We suggest foreign body reaction be considered in the differential diagnosis for a persistently painful shoulder after biologic glenoid resurfacing using an acellular allograft patch. © 2013 The Association of Bone and Joint Surgeons®. Source

Kamath A.F.,University of Pennsylvania | Sheth N.P.,Hip and Knee Center | Hosalkar H.H.,University of California at San Diego | Babatunde O.M.,Columbia University Medical Center | And 2 more authors.
Journal of Arthroplasty

Total hip arthroplasty (THA) is not commonly performed in adolescents. However, it may be the only option for pain control with continued mobility for advanced disease. We report our experience with modern alternative-bearing THA in patients younger than 21 years. Twenty-one THAs (18 patients) were followed. Preoperative and postoperative Harris hip scores were recorded, and radiographs were reviewed. Average follow-up was 49 months (range, 25-89). Underlying etiology was chemotherapy-induced osteonecrosis (33%), steroid-induced osteonecrosis (29%), sickle cell disease (24%), and chronic dislocation (14%). Articulation bearings were ceramic/ceramic (67%), metal/highly cross-linked polyethylene (29%), and metal resurfacing (5%). Mean age was 18 years (range, 13-20). Harris hip scores improved from 43.6 to 83.6 (P <.001). At final follow-up, there was no radiographic loosening; 1 THA was revised for a cracked ceramic liner. At intermediate-term follow-up, clinical and radiographic results are favorable after alternative-bearing THA in patients younger than 21 years. © 2012 Elsevier Inc. Source

Kim T.W.B.,University of Pennsylvania | Kamath A.F.,University of Pennsylvania | Israelite C.L.,Penn Presbyterian Medical Center
Journal of Arthroplasty

Disruption of the extensor mechanism after total knee arthroplasty (TKA) is a devastating complication, usually requiring surgical repair. Although suture anchor fixation is well described for repair of the ruptured native knee quadriceps tendon, no study has discussed the use of suture anchors in quadriceps repair after TKA. We present an illustrative case of successful suture anchor fixation of the quadriceps mechanism after TKA. The procedure has been performed in a total of 3 patients. A surgical technique and brief review of the literature follows. Suture anchor fixation of the quadriceps tendon is a viable option in the setting of rupture after TKA. © 2011 Elsevier Inc. Source

Bozentka D.J.,University of Pennsylvania | Bozentka D.J.,Penn Presbyterian Medical Center
Hand Clinics

Resection arthroplasty with or without ligament reconstruction for thumb trapeziometacarpal arthritis can be complicated by thumb shortening and pinch-strength weakness. Implant arthroplasties have been developed to limit loss of thumb length, improve strength, and limit postoperative convalescence. The ideal thumb carpometacarpal implant should be strong and stable, provide full range of motion, and prevent loosening. Unfortunately, no current prosthesis accomplishes all of these goals. Until the ideal implant is developed, clinical acumen must be used to determine appropriate patients and implants. © 2010 Elsevier Inc. Source

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