Replacement Arthroplasty: Mont MA

Mont MA, Seyler TM. · No affiliation provided · Clin Orthop Relat Res. · Pubmed #19263181 No free full text.

This publication has no abstract.

Mont MA, Ranawat CS. · Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland. · J Arthroplasty. · Pubmed #17919583 No free full text.

This publication has no abstract.

Burgess DL, McGrath MS, Bonutti PM, Marker DR, Delanois RE, Mont MA. · Department of Orthopaedic Surgery, Howard University Hospital, Washington, DC 20060, USA. · J Bone Joint Surg Am. · Pubmed #19411474 No free full text.

Abstract: Resurfacing is a type of shoulder arthroplasty that involves replacing the humeral joint surface with a metal covering, or cap, thus preserving the bone of the proximal part of the humerus. If the glenoid is also replaced, a current conventional polyethylene glenoid replacement prosthesis or an interposed soft-tissue graft is used. The potential advantages of humeral resurfacing, as compared with conventional shoulder arthroplasty, are: (1) no osteotomy is performed (and thus the head-shaft angle does not have to be addressed); (2) minimal bone resection; (3) a short operative time; (4) a low prevalence of humeral periprosthetic fractures; and (5) ease of revision to a conventional total shoulder replacement, if needed. Outcomes of surface replacement arthroplasty have been comparable with those of arthroplasties with a stemmed prosthesis in numerous short and mid-term follow-up studies. Future studies are required to assess the long-term outcomes of humeral resurfacing and to evaluate alternative surface bearing materials, especially on the glenoid side. Resurfacing appears to be a viable option for shoulder replacement, especially in young patients.

Mont MA, McGrath MS, Bonutti PM, Ulrich SD, Marker DR, Seyler TM, Suda AJ. · Rubin Institute for Advanced Orthopaedics, Baltimore, MD 21215, USA. · Expert Rev Med Devices. · Pubmed #19298164 No free full text.

Abstract: A number of patients have anatomic or physiologic variations that may adversely affect the performance of a primary total hip arthroplasty. Various technologies have been utilized in an attempt to improve the outcomes for these patients; however, some of these potential solutions are controversial. The authors examined the complete body of literature for scientific evidence regarding the use of these new technologies. The anatomic and physiologic anomalies that were studied include extra-articular deformities, developmental dysplasia, Perthes disease, Type C femoral bone, acetabular bone deficiency, femoral rotational abnormalities, variations that increase the risk of hip dislocation, sickle cell anemia, and extremely small or large bone sizes. This article presents the current scientific evidence and imparts an unbiased view of the use of various technologies to provide individualized solutions for patients who have anatomic or physiologic variations.

McGrath MS, Suda AJ, Bonutti PM, Zywiel MG, Marker DR, Seyler TM, Mont MA. · Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA. · Expert Rev Med Devices. · Pubmed #19105782 No free full text.

Abstract: Primary total knee arthroplasties have high success rates, but certain patient anatomic or other variations may adversely affect the performance or the clinical outcomes of these procedures. Various technologies and techniques have been developed in attempts to overcome these challenges. However, there is controversy concerning whether these innovations are beneficial. This article assessed the scientific evidence regarding the use of these technologies to address various anatomic variations by examining the complete body of literature. The anatomic variations that were examined included extra-articular deformities, bone deficiencies, ligamentous instability, post-patellectomy knees, patella baja, variations in bone size and high-flexion knees. Recommendations for each circumstance were presented based upon the available scientific evidence.

Seyler TM, Smith BP, Marker DR, Ma J, Shen J, Smith TL, Mont MA, Kolaski K, Koman LA. · Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1070, USA. · J Bone Joint Surg Am. · Pubmed #18984726 No free full text.

This publication has no abstract.

Quesada MJ, Marker DR, Mont MA. · Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopaedics, Sinai Hospital of Baltimore, Baltimore, Maryland 21215, USA. · J Arthroplasty. · Pubmed #18922377 No free full text.

Abstract: Modern metal-on-metal resurfacing has recently gained popularity as an alternative to standard stemmed total hip arthroplasty. This study analyzed, from a literature review, the purported advantages and disadvantages of resurfacing with a comparison to standard hip arthroplasty. Advantages may include bone conservation on the femoral side with possible lower dislocation rates, more range-of-motion, more normal gait pattern, increased activity levels, increased ease of insertion with proximal femoral deformities or retained hardware, and straightforward revision. Possible disadvantages of resurfacing are increased difficulty to perform the procedure, increased acetabular bone stock loss, femoral neck fractures, and concerns about the effects of metal ions. Many of these issues will need further clarification by well-planned prospective studies and evaluation of longer-term outcomes.

Sikes CV, Lai LP, Schreiber M, Mont MA, Jinnah RH, Seyler TM. · Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1070, USA. · J Arthroplasty. · Pubmed #18922375 No free full text.

Abstract: One of the most common complications after total hip arthroplasty is instability. This study reviewed the recent literature concerning the indications, contraindications, and results of recent studies using both constrained liners and large femoral heads to treat instability after total hip arthroplasty. We also report on the results of a series of 41 patients (52 hips) considered being at high risk for dislocation who were treated with large-diameter metal-on-metal bearings and who were compared with a matched group of hips treated with standard-size metal-on-polyethylene bearings. The large-diameter femoral head group had no dislocations at a minimum follow-up of 24 months, whereas the standard-size group had 2 dislocations. We support the use of large femoral heads to treat instability in a wide variety of patients because of the increased stability, decreased wear of modern metal-on-metal designs, increased range of motion, and variety of revision options.

Huo MH, Parvizi J, Bal BS, Mont MA, Anonymous00317. · Department of Orthopaedic Surgery, UT Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390-8883, USA. · J Bone Joint Surg Am. · Pubmed #18762667 No free full text.

This publication has no abstract.

Delanois RE, McGrath MS, Ulrich SD, Marker DR, Seyler TM, Bonutti PM, Mont MA. · Center for Joint Preservation and Reconstruction, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA. · Orthop Clin North Am. · Pubmed #18602566 No free full text.

Abstract: Many procedures have been used to treat advanced isolated patellofemoral arthritis, with varying results. Patellofemoral arthroplasty (PFA) is a bone-conserving procedure that has shown short-term success but has relatively high revision rates. Total knee arthroplasty (TKA) has been recommended for treatment of this disease in patients who are older than 60 years of age. Recent literature indicates that PFA is most successful in patients who have isolated patellofemoral arthritis secondary to trochlear dysplasia or patellar fracture and in patients who are younger than 60 years; TKA is recommended for older patients who have primary or idiopathic isolated patellofemoral arthritis.

Akbar M, Mont MA, Heisel C, Marker DR, Ulrich SD, Seyler TM. · Stiftung Orthopädische Universitätsklinik, Heidelberg. · Orthopade. · Pubmed #18542917 No free full text.

Abstract: Osteonecrosis of the femoral head is a disease of the young patient which eventually destroys the hip joint. In the early stage of the disease, treatment options are aimed at preserving the femoral head. Unfortunately, many patients present with late-stage disease (Ficat III and IV).In late-stage disease the treatment of choice is total hip arthroplasty. The high failure rate of total hip arthroplasty in young patients with osteonecrosis of the femoral head, however, made it an unfavourable treatment option. The results of hemiresurfacing (femoral resurfacing) in this patient population have been very disappointing due to high revision rates and insufficient pain relief. More recently, promising short- and mid-term results were reported with the use of total resurfacing with a survivorship of 90-93% after 3.4-10 years. Our own results in 60 patients show an overall survivorship of 92% after a mean follow-up of 4.8 years (1.6-6.5 years). Total hip resurfacing is a valuable treatment option for late-stage osteonecrosis based on recent study results.

Stiehl JB, Ulrich SD, Seyler TM, Bonutti PM, Marker DR, Mont MA. · Orthopaedic Surgeon, Orthopedic Hospital of Wisconsin, 575 W River Woods Parkway, Milwaukee, WI 53212, USA. · Expert Rev Med Devices. · Pubmed #18331183 No free full text.

Abstract: This review provides an overview of the use of bone morphogenetic proteins to enhance bone healing and bone graft incorporation in difficult defects created from failed total hip arthroplasties, osteonecrosis of the femoral head and trauma. Multiple publications have demonstrated that bone morphogenetic proteins are osteoinductive in preclinical trials (i.e., animal models); however, there is controversy and limited understanding of the use of this technology in orthopedic surgical practice. The question remains as to whether they are useful in difficult fractures, nonunions and large defects created from failed total hip arthroplasty or femoral head osteonecrosis. There might be a small risk for infection by the process of introducing foreign materials in a clinical situation, but this has not yet been realized to date. In addition, these materials offer an advantage in large defects where there is not enough transplantable material available from the host. We believe that the use of these materials will become more widespread with newer carriers, minimally invasive applications and diminished commercial costs.

Ulrich SD, Bonutti PM, Seyler TM, Marker DR, Jones LC, Mont MA. · Rubin Institute for Advanced Orthopaedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA. · Expert Rev Med Devices. · Pubmed #18035952 No free full text.

Abstract: Minimally invasive surgeries, as well as computer-assisted surgery for total hip replacement have gained popularity over recent years. This article provides an overview of state-of-the-art minimally invasive surgery (MIS) and computer-assisted surgery for total hip arthroplasty. A comprehensive review of the literature for scientific evidence supporting the use of these technologies was undertaken. This review evaluates whether commonly asked questions concerning these topics have been addressed. Controversy remains as to whether there are significant benefits of MIS or computer-assisted surgery for total hip arthroplasty. Fortunately, most studies report similar outcomes for both technologies. Minimally invasive techniques have been developed that do not significantly increase operative time or immediate postoperative complications. Computer-assisted navigation has shown improved radiographic alignment for total hip arthroplasty and may allow MIS to be performed more optimally. The authors believe that both of these technologies are likely to have a place in the future for hip arthroplasty with expectations of increased successful outcomes with these techniques while lowering complications and costs. Long-term outcomes of both techniques will need to be investigated.

Seyler TM, Marker DR, Bhave A, Plate JF, Marulanda GA, Bonutti PM, Delanois RE, Mont MA. · Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, MD 21215, USA. · J Bone Joint Surg Am. · Pubmed #17908871 No free full text.

This publication has no abstract.

Ulrich SD, Mont MA, Bonutti PM, Seyler TM, Marker DR, Jones LC. · Rubin Institute for Advanced Orthopaedics, Center for Joint Preservation and Replacement, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA. · Expert Rev Med Devices. · Pubmed #17605685 No free full text.

Abstract: This review provides an overview of the field of minimally invasive surgery and computer-assisted surgery for total knee arthroplasty. The authors have examined the complete body of literature for scientific evidence supporting the use of these new technologies and how the literature specifically supports commonly asked questions. There is controversy concerning the benefits of minimally invasive surgery and computer-assisted surgery for total knee arthroplasty. However, in most studies the results are similar for minimally invasive surgery compared to standard approaches. Computer-assisted navigation has been found in some studies to improve radiographic alignment of total knee arthroplasty. The authors believe that there is evidence for both technologies to be at least equivalent in terms of results, as well as expectations of increased success with the techniques. Both technologies have led manufacturers to invest more effort into newer prosthetic instrumentations and designs to facilitate these techniques.

Seyler TM, Cui Q, Mihalko WM, Mont MA, Saleh KJ. · Rubin Institute for Advanced Orthopedics, Sinai Hospital, Baltimore, Maryland, USA. · Instr Course Lect. · Pubmed #17472309 No free full text.

Abstract: Osteonecrosis of the femoral head is a devastating disease for which many patients will eventually require total hip arthroplasty. Standard total hip arthroplasties have historically had poor results in patients with osteonecrosis. More recently, reports have shown excellent results with second- and third-generation designs that incorporate advances in bearing technology. However, there are still certain subpopulations of patients (those with sickle cell disease, those with systemic lupus erythematosus, and those who have undergone renal transplantation) that have less than optimal results. Other hip arthroplasty alternatives include bipolar hemiarthroplasty, limited femoral resurfacing, and metal-on-metal resurfacing. Bipolar hemiarthroplasty historically and currently has consistently poor results in most studies and should be avoided in patients with osteonecrosis. In multiple reports, limited femoral arthroplasty has demonstrated reasonable midterm and long-term outcomes as a temporizing procedure, with results being less predictable than for standard total hip arthroplasty. Recently, ceramic-on-ceramic and metal-on-metal resurfacing hip arthroplasty has emerged as a viable option that has been used to treat patients with osteonecrosis of the femoral head, and several studies have shown promising short-term outcomes. Overall, however, recent studies have shown more optimal outcomes with hip arthroplasty than resurfacing hip arthroplasty, which makes standard hip replacements, as well as other arthroplasty alternatives, more attractive for young patients with this disease.

Leadbetter WB, Seyler TM, Ragland PS, Mont MA. · Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA. · J Bone Joint Surg Am. · Pubmed #17142442 No free full text.

This publication has no abstract.

Bezwada HR, Nazarian DG, Henry DH, Booth RE, Mont MA. · Balderston Orthopaedics, Pennsylvania Hospital, 800 Spruce St., Philadelphia, PA 19107, USA. · Am J Orthop. · Pubmed #17131735 No free full text.

Abstract: Blood loss associated with total joint arthroplasty can be substantial. Various techniques for dealing with such blood loss include allogeneic blood programs, preadmission donation programs, pharmacologic agents, hemodilution, and perioperative blood salvage. This article reviews these techniques as well as the consequences of perioperative anemia. Problems associated with blood transfusions are also outlined.

Seyler TM, Etienne G, Plate JF, Fisher P, Mont MA. · Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Reconstruction, Sinai Hospital of Baltimore, Baltimore, Maryland, USA. · Surg Technol Int. · Pubmed #17029179 No free full text.

Abstract: The use of large-diameter femoral heads in total hip arthroplasty appears to reduce the risk for dislocation, and potentially improve articular wear. Moreover, large-diameter total hip femoral heads have been determined to increase range of motion. The purpose of this study was to report our experiences with this new device. In our patient cohort, many patients have done extremely well in the short-term with this new device, and it seems these patients function better than those with a standard total hip arthroplasty. The patients who experience less pain are able to return to full activities postoperatively. The preliminary results of this study are encouraging, and large femoral head prosthesis appears to be a great choice for orthopaedic surgeons in primary total hip arthroplasty.

Parvizi J, Campfield A, Clohisy JC, Rothman RH, Mont MA. · Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA. · J Bone Joint Surg Br. · Pubmed #17012414 No free full text.

Abstract: Arthritis of the hip in the young adult can be a disabling condition. Recent years have witnessed extensive research related to the management of this condition. This article reviews the current status with regard to aetiology, diagnosis and treatment of arthritis of the hip in the young adult.

Mont MA, Ragland PS, Parvizi J. · Department of Orthopaedics, Sinai Hospital of Baltimore, Baltimore, Maryland, USA. · Instr Course Lect. · Pubmed #16958449 No free full text.

Abstract: Various surgical procedures are used in patients with osteonecrosis of the hip. Patients with precollapse of the femoral head are generally treated with head-preserving procedures (core decompression, various bone grafting techniques, and osteotomies), whereas those with collapse of the femoral head and/or arthritis may require arthroplasty. The arthroplasty options available include limited femoral resurfacing arthroplasty, metal-on-metal resurfacing arthroplasty, or total hip replacement. The indications, techniques, and early outcomes of some of these procedures for treatment of osteonecrosis of the hip merit discussion.

Mont MA, Ragland PS, Etienne G, Seyler TM, Schmalzried TP. · Center for Joint Preservation and Reconstruction, Rubin Institute for Advanced Orthopaedics, Sinai Hospital of Baltimore, MD 21215, USA. · J Am Acad Orthop Surg. · Pubmed #16885477 No free full text.

Abstract: Hip resurfacing arthroplasty is a type of hip replacement that involves capping the femoral head and preserving bone of the proximal femur. Metal-on-metal surface replacements have been manufactured since the early 1990s. Recent studies indicate excellent clinical results with low failure rates at 1- to 5-year follow-up. Although these early results are encouraging, resurfacing devices must be used with caution because less is known about their long-term safety and efficacy. The best candidates for resurfacing are patients younger than age 60 years with good bone stock. The surgical approach is similar to that for standard total hip replacements, but with slightly more dissection because the femoral head must be preserved and displaced to visualize the acetabulum. To reduce complications, resurfacing arthroplasty should be performed by surgeons who have received training specifically in this technique.

Seyler TM, Mont MA, Ragland PS, Kachwala MM, Delanois RE. · Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Reconstruction, Baltimore, Maryland 21215, USA. · Sports Med. · Pubmed #16796395 No free full text.

Abstract: Lower extremity total joint arthroplasties are among the most successful operations in orthopaedics. Presently, it appears that some patients wish to not only have general functions restored, but also desire the opportunity to return or continue on a high level of activity. This review summarises the literature concerning athletic activity, and tennis in particular, in relation to lower extremity total joint arthroplasties. Orthopaedic surgeons frequently recommend participation in low-impact sports such as swimming, walking, bicycling, bowling and golf. The patient's return to these recreational activities appears to be without problems. In contrast, there has been a general consensus from surgeons to avoid high-impact sports such as tennis and jogging after total joint arthroplasty, but there have been numerous studies that reported functional results being compatible with these activity levels. Conflicts emerge with some studies that describe lower survival rates for hip and knee arthroplasty in patients participating in high-impact sports. Most of these studies report that participation in sporting activities following total joint arthroplasty refers to increased polyethylene wear and debris, which could eventually result in implant failure. With recent advances in implant technology and surgical technique, the survival rates for modern prosthetic designs and patients with these high demands are promising. Various studies assessing the association between clinical outcome and participation in tennis did not demonstrate a harmful effect on implant survival rates. Although the majority of these studies do not reflect a true representation of the average patient undergoing total joint arthroplasty, more surgeons are confronted with the patients' desire to continue with sports activity. To optimise results, patients who demand higher levels of activity must be carefully selected, and must have the motivation and drive to optimise their results. In general, all patients should be encouraged to remain physically active to improve general health, maintain good bone quality, and improve implant fixation. There is still a need for prospective, randomised controlled studies concerning high activity and its impact on total joint arthroplasty.

Macaulay W, Pagnotto MR, Iorio R, Mont MA, Saleh KJ. · Center of Hip and Knee Replacement, and Department of Orthopaedic Surgery, Columbia University, New York, NY 10032, USA. · J Am Acad Orthop Surg. · Pubmed #16675622 No free full text.

Abstract: The incidence of femoral neck fracture among the elderly in the United States is expected to increase dramatically because of the anticipated explosion in the population aged 65 years and older, increased life expectancy, and the rising incidence of osteoporosis. The resulting public health implications may be significant, with annual hospital admissions resulting from hip fracture projected to increase to 700,000 by 2050, and with annual spending on hip fracture care expected to exceed 15 billion dollars within a few years. The decision to perform internal fixation, unipolar hemiarthroplasty, bipolar hemiarthroplasty, or THA must be based on patient mental status, living arrangement, level of independence and activity, and bone and joint quality.

Leadbetter WB, Ragland PS, Mont MA. · Rubin Institute for Advanced Orthopaedics, Sinai Hospital of Baltimore, MD 21215, USA. · Clin Orthop Relat Res. · Pubmed #15995426 No free full text.

Abstract: Patellofemoral arthroplasty is going through a recent resurgence in interest with various new designs being introduced for general orthopaedic use. With this renewed enthusiasm for the procedure, it is important to understand the various indications and contraindications for using patellofemoral arthroplasty devices with the expectation that proper patient selection will improve outcome. Our purpose was to analyze the appropriate usage of these prostheses based on published historical results. A literature search was done to review the indications, contraindications, and factors contributing to the failure of these devices. We analyzed 12 studies reporting results of patellofemoral arthroplasty between 1979 and 2005. Commonly cited contraindications for using these devices have been tibiofemoral arthritis, uncorrected patellofemoral or tibiofemoral malalignment, and inflammatory arthritis. The highest failure rates were in patients with progression of osteoarthritis in other compartments or persistence of congenital or surgically uncorrected malalignment. In analyzing the reasons for failures in these reports together with issues already known to affect total knee arthroplasty surgery, we suggest an expanded list of outcome-altering factors to consider when choosing to do a patellofemoral arthroplasty. Finally, based on these observations and our own experience, suggestions on the best approach to the patient with patellofemoral arthritis are made to avoid less than optimal results if patellofemoral arthroplasty is considered. LEVEL OF EVIDENCE: Prognostic Study, Level II-3 (systematic review of Level-II studies. See the Guidelines for Authors for a complete description of levels of evidence.