Replacement Arthroplasty: Babis GC

Babis GC, Soucacos PN. · No affiliation provided · J Surg Orthop Adv. · Pubmed #18851796 No free full text.

This publication has no abstract.

Babis GC, Soucacos PN. · First Department of Orthopaedic Surgery, University of Athens Medical School, KAT Hospital, 2 Nikis Street, Kifissia 14561, Athens, Greece. · Orthop Clin North Am. · Pubmed #15271544 No free full text.

Abstract: Total hip replacement initially showed universally bad results when performed in hips with advanced stages of osteonecrosis. Newer techniques and implants remarkably improved these results. Today cementless or hybrid total hip arthroplasty for osteonecrosis is proven to be safe and effective and to have survivorship similar to cases with osteoarthritis. Newer,more durable bearing surfaces will further improve the longevity of this procedure.

Mavrodontidis AN, Andrikoula SI, Kontogeorgakos VA, Babis GC, Xenakis TA, Beris AE, Soucacos PN. · Department of Orthopaedic Surgery, University of Ioannina, School of Medicine, Ioannina, Greece. · J Surg Orthop Adv. · Pubmed #18851803 No free full text.

Abstract: One hundred thirty-six knees were treated with the Endomodel rotating hinge knee prosthesis as primary total knee arthroplasty (TKA). The indications for surgery included osteoarthritis (110 knees), rheumatoid arthritis (18 knees), and osteonecrosis (8 knees). Patients were divided into four study groups according to follow-up duration. Group A was followed up from 10 to 15 years, group B from 8 to 10 years, group C from 5 to 8 years, and group D from 2 to 5 years. The Hospital for Special Surgery knee score, as well as each parameter individually, showed statistically significant improvement in all groups postoperatively. A total of 88.23% were rated as excellent, 3.67% as good, and 8.08% as fair. The results suggest that the Endomodel rotating hinge prosthesis can be considered a good alternative for primary TKA in cases of serious axial deformity and collateral ligament deficiency and in rheumatoid arthritis patients.

Babis GC, Zahos KA, Tsailas P, Karaliotas GI, Kanellakopoulou K, Soucacos PN. · Department of Orthopaedic Surgery, University of Athens, School of Medicine, Athens, Greece. · J Surg Orthop Adv. · Pubmed #18851802 No free full text.

Abstract: The incidence of periprosthetic knee infection is generally low, but the economic impact is great. Treatment should take into account the acuteness of the infection, the overall immune/medical status of the patient, and the local factors at the site of the infection. The aim of this study was to evaluate the two-phase exchange arthroplasty with the use of antibiotic-impregnated articulating spacer, as an alternative treatment of chronic periprosthetic knee infection in patients with minimum systemic and no local compromising factors. Staphylococcus aureus was the most common pathogen followed by Staphylococcus epidermidis and Pseudomonas aeruginosa. Twenty-four patients were treated with this regiment. All of them returned to normal everyday activity and no infection recurrence was noted over a 2- to 10-year follow-up. Excellent long-term results can be achieved for patients staged as III-A-1 and III-B-1 according to the Musculoskeletal Infection Society staging system, when treated with the aforementioned protocol and intravenous antibiotics.

Hartofilakidis G, Georgiades G, Babis GC, Yiannakopoulos CK. · University of Athens Medical School, 21 Fotiou, Patriarchou Street, Athens 11471, Greece. · J Bone Joint Surg Br. · Pubmed #18539664 No free full text.

Abstract: We have evaluated the results of total hip replacement in patients with congenital hip disease using 46 cemented all-polyethylene Charnley acetabular components implanted with the cotyloplasty technique in 34 patients (group A), and compared them with 47 metal-backed cementless acetabular components implanted without bone grafting in 33 patients (group B). Patients in group A were treated between 1988 and 1993 and those in group B between 1990 and 1995. The mean follow-up for group A was 16.6 years (12 to 18) and the mean follow-up for group B was 13.4 years (10 to 16). Revision for aseptic loosening was undertaken in 15 hips (32.6%) in group A and in four hips (8.5%) in group B. When liner exchange was included, a total of 13 hips were revised in group B (27.7%). The mean polyethylene wear was 0.11 mm/yr (0.002 to 0.43) and 0.107 mm/yr (0 to 0.62) for groups A and B, respectively. Polyethylene wear in group A was associated with linear osteolysis, and in group B with expansile osteolysis. In patients with congenital hip disease, when 80% cover of the implant can be obtained, a cementless acetabular component appears to be acceptable and provides durable fixation. However, because of the type of osteolysis arising with these devices, early exchange of a worn liner is recommended before extensive bone loss makes revision surgery more complicated.

Hartofilakidis G, Georgiades G, Babis GC. · University of Athens Medical School, Athens, Greece. · J Arthroplasty. · Pubmed #18534419 No free full text.

Abstract: We compared, after a 10-year-minimum follow-up, the outcome of 50 cemented all-polyethylene Charnley acetabular sockets with that of 51 cementless metal-backed sockets in 2 comparable cohorts of young patients. Although the revision rate for the cemented and cementless group was 28% and 35%, respectively, the revision rate for aseptic loosening was 28% for the cemented and 12% for the cementless group. The mean polyethylene wear was 0.112 and 0.114 mm/y, respectively, for the 2 groups. Linear osteolysis was observed in 18 of 50 cemented sockets. Expansile osteolysis presented in 10 of 51 cementless sockets and only in one of the cemented sockets. In conclusion, cementless components had more durable fixation than cemented components. However, they presented more aggressive expansile osteolysis caused by the coexistence of polyethylene and metal debris.

Babis GC, An KN, Chao EY, Rand JA, Sim FH. · Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA. · J Bone Joint Surg Am. · Pubmed #12177268 No free full text.

Abstract: BACKGROUND: Although general guidelines have been proposed for proximal tibial and supracondylar osteotomies, double level osteotomy provides the advantage of maintaining neutral joint-line obliquity in addition to correcting limb malalignment around the knee. The goal of this prospective study was to determine the outcome of double level osteotomy of the knee performed after analysis with computer-aided preoperative planning software in patients with varus malalignment. METHODS: Twenty-nine double level osteotomies of the knee were performed in twenty-four patients. The patients were followed for an average duration of 82.7 months (range, twenty-seven to 137 months). All knees had moderate-to-severe varus deformity and arthritis. The mean preoperative mechanical tibiofemoral angle was 193.9 degrees (that is, 13.9 degrees of varus). Preoperative and postoperative evaluations included clinical (scores according to the Knee Society system), radiographic, and computer-aided analysis of the mechanical status of the knee joint. Failure was defined as conversion of an osteotomy to a total knee arthroplasty or the presence of severe pain in a patient who declined arthroplasty. RESULTS: The mean clinical and functional scores according to the Knee Society system improved from 34 and 64 points, respectively, before the osteotomy to 90 (p < 0.0001) and 81 points (p = 0.079) at the time of the final follow-up examination. One patient was lost to follow-up. One of the twenty-nine knees was subsequently converted to total knee arthroplasty forty-nine months postoperatively. The cumulative rate of survival at 100 months was 96% (95% confidence interval, +4.5 to -8.7), with eight patients remaining at risk. CONCLUSIONS: Double osteotomy is a valuable procedure for patients with such a large varus deformity that appropriate realignment and load transfer to the unaffected compartment, together with an acceptable joint-line obliquity, cannot be achieved by a single osteotomy.

Babis GC, Trousdale RT, Morrey BF. · Department of Orthopaedic Surgery, University of Athens, Athens, Greece. · J Bone Joint Surg Am. · Pubmed #11792781 No free full text.

Abstract: BACKGROUND: Despite improvements in the design and manufacturing of the components used in total knee arthroplasty, wear of the polyethylene bearing remains a potential source of failure. One theoretical advantage of modular tibial implants is that, when the components are well fixed, patients with wear or instability of the tibial insert can be treated with isolated polyethylene exchange. The aim of this study was to assess the results of isolated tibial insert exchange during revision surgery in a relatively large, consecutive group of patients. METHODS: From 1985 through 1997, we performed fifty-six isolated tibial insert exchanges in fifty-five patients (twenty-nine men [one man had bilateral revision] and twenty-six women; mean age, sixty-six years) primarily because of wear or instability. Patients with loosening of any of the components, a history of infection, severe stiffness of the knee, recognized malposition of any component, or problems with the extensor mechanism were excluded. Twelve knees had had one, two, or three prior revisions. The duration of follow-up averaged 8.3 years (range, 1.6 to 16.2 years) after the index arthroplasty and 4.6 years (range, two to fourteen years) after the revision. RESULTS: The mean Knee Society knee and function scores improved from 56 and 50.9 points prior to the revision to 76 and 59 points at the time of final follopcow-up. Fourteen (25%) of the fifty-six knees subsequently required rerevision at a mean of only three years (range, 0.5 to 6.8 years) after the tibial insert exchange. The cumulative survival rate at 5.5 years was 63.5% (95% confidence interval, 14.4%, with nineteen patients remaining at risk). Of the twenty-seven knees with preoperative instability, eight were rerevised and another four were considered failures because of severe pain. Of the twenty-four knees that were treated with the index revision because of wear of the insert, five were rerevised. In addition, one extremity in this group was amputated above the knee as a result of chronic osteomyelitis of the ankle concomitant with chronic pain at the site of the total knee arthroplasty and another two inserts were considered failures because of severe pain. CONCLUSIONS: Isolated tibial insert exchange led to a surprisingly high rate of early failure. Tibial insert exchange as an isolated method of total knee revision should therefore be undertaken with caution even in circumstances for which the modular insert was designed and believed to be of greatest value.

Babis GC, Trousdale RT, Pagnano MW, Morrey BF. · Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA. · J Bone Joint Surg Am. · Pubmed #11679605 No free full text.

Abstract: BACKGROUND: Severe stiffness after total knee arthroplasty is a debilitating problem. In patients with securely fixed and appropriately aligned components, arthrolysis of adhesions and exchange to a thinner tibial polyethylene insert may appear to be a reasonable and logical solution. We reviewed our experience with this procedure to determine its efficacy. METHODS: From 1992 through 1998, seven knees with marked stiffness after total knee arthroplasty were treated at our institution with arthrolysis of adhesions and conversion to a thinner tibial polyethylene insert. Only patients in whom the total knee prosthesis was well aligned, well fixed, and not associated with infection were included. There were five women and two men with a mean age at revision of sixty-one years (range, thirty-eight to seventy-four years). The average time to revision was twelve months, and the mean arc of motion prior to revision was 38.6 degrees (range, 15 degrees to 60 degrees ). The duration of follow-up after the insert exchange averaged 4.2 years (range, two to eight years). RESULTS: Mean Knee Society pain and function scores changed from 44 and 36.4 points preoperatively to 39.6 and 46 points at the time of final follow-up. Two knees were rerevised, one because of infection and the other because of aseptic loosening of the components. The five remaining knees were painful and stiff at the time of final follow-up. Four of these five knees were severely painful, and one knee was moderately and occasionally painful. The mean arc of motion of these five knees was 58 degrees (range, 40 degrees to 70 degrees ) at the time of final follow-up. CONCLUSION: Isolated tibial insert exchange, arthrolysis, and débridement failed to provide a viable solution to the difficult and poorly understood problem of knee stiffness in a group of carefully selected patients following total knee arthroplasty. We therefore have little enthusiasm for the continued use of this strategy.