Edward Adler, M.D.

Effect of a perioperative intra-articular injection on pain control and early range of motion following bilateral TKA
Fajardo, Marc; Collins, Jason; Landa, Joshua; Adler, Edward; Meere, Patrick; Di Cesare, Paul E
2011 May;34(5):354-354, Orthopedics (Thorofare NJ)
Pain control after total knee arthroplasty (TKA) is integral in the immediate postoperative period for early rehabilitation. Numerous different methods of postoperative analgesia are available, but each has its own risk of adverse side effects. This study was performed to prospectively evaluate the benefits of an intra-articular analgesic injection in patients undergoing bilateral TKA.Thirty consecutive patients undergoing bilateral TKA were enrolled in this prospective, randomized, controlled study. Each patient was randomized to receive (1) a perioperative intra-articular mixture of morphine, bupivacaine with epinephrine, and ketorolac in 1 knee, and (2) injectable sterile saline in the contralateral knee. Each patient acted as his or her own internal control. The pharmacologically injected knee had statistically significantly less pain immediately postoperatively when compared to the control knee and displayed significantly increased range of motion within the first week of rehabilitation.The use of an intraoperative intra-articular injection with the above drug combination significantly reduces patient pain and increases postoperative mobility with no apparent risks following bilateral TKA
— id: 134721, year: 2011, vol: 34, page: 354, stat: Journal Article,

Obturator dislocation of total hip arthroplasty--a case report
Glassner, Philip J; Adler, Edward M; Jaffe, William L
2009 ;67(4):381-383, Bulletin of the NYU Hospital for Joint Diseases
This study consists of a single case report of a patient who had an irreducible obturator dislocation of a total hip arthroplasty after a motor vehicle accident, not previously described in the English literature. In particular, the focus will be on offering an educated opinion on the risk factors for dislocation and difficulties encountered with this type of dislocation. The aim is to offer valuable insight based on the operative experience with this patient and to supplement the literature with the management of such a complication following total hip arthroplasty
— id: 105977, year: 2009, vol: 67, page: 381, stat: Journal Article,

Granulomatous inflammation after Hylan G-F 20 viscosupplementation of the knee : a report of six cases
Chen, Andrew L; Desai, Panna; Adler, Edward M; Di Cesare, Paul E
2002 Jul;84-A(7):1142-1147, Journal of bone & joint surgery (American volume)
BACKGROUND: Recently, intra-articular viscosupplementation with hyaluronate-derived products has gained popularity as a palliative modality for the treatment of osteoarthritis of the knee. Mild pain or swelling at the site of injection may occur in up to 20% of patients, although severe local inflammation, warmth, and joint effusion are rare. We present a series of six cases in which granulomatous inflammation of the synovium was observed after hyaluronate viscosupplementation of the knee. METHODS: Six knees (five patients) treated with intra-articular Hylan G-F 20 viscosupplementation underwent a surgical procedure because of persistent symptoms. Routine histopathological evaluation, supplemented by alcian-blue staining and hyaluronidase digestion, was performed in each case. RESULTS: Chronically inflamed synovium with areas of histiocytic and foreign-body giant-cell reaction was observed surrounding acellular, amorphous material. The material stained with alcian blue, a stain for hyaluronate, which disappeared after hyaluronidase digestion. CONCLUSIONS: We believe that the injected hyaluronate (Hylan G-F 20) may have been responsible for the synovitis in our patients and thus may be a pathological cause of recalcitrant symptoms after such injection. It is not known whether the responsible pathological agent was the hyaluronate derivative, a contaminant of the purification process, or a component of the carrier substance. Importantly, it appears that the findings in these patients most likely represent a previously unreported pathological response to a viscosupplementation product. This report should raise clinical awareness about this potential complication
— id: 71260, year: 2002, vol: 84-A, page: 1142, stat: Journal Article,

Radiographic comparison of grit-blasted hydroxyaptite and arc-deposited hydroxyapatite acetabular components. A four-year follow-up study
Jazrawi LM; Adler EM; Jazrawi AJ; Jaffe WL
2000 ;59(3):144-148, Bulletin (Hospital for Joint Diseases)
High rates of aseptic loosening have been reported for microstructured hydroxyapatite-coated acetabular components. A macrostructured component surface (arc-deposition) not only improves resistance to shear forces experienced by the acetabular component and increases initial stability, but also provides channels for bone ingrowth. The purpose of this investigation was to radiographically compare a series of grit-blasted (microstructured) and arc-deposited (macrostructured) hydroxyapatite-coated acetabular components. A minimum 4-year retrospective radiographic analysis of acetabular components was performed on a total of 50 total hip arthroplasties. At 4 years, arc-deposited components were associated with fewer radiolucent lines in all Charnley zones, particularly Charnley zone III. While the 4-year results for arc-deposited hydroxyapatite acetabular components are superior to their microstructured predecessors, long-term results are still unknown
— id: 32646, year: 2000, vol: 59, page: 144, stat: Journal Article,

Analysis of frozen sections of intraoperative specimens obtained at the time of reoperation after hip or knee resection arthroplasty for the treatment of infection
Della Valle CJ; Bogner E; Desai P; Lonner JH; Adler E; Zuckerman JD; Di Cesare PE
1999 May;81(5):684-689, Journal of bone & joint surgery (American volume)
BACKGROUND: Despite the effectiveness of a two-stage exchange protocol for the treatment of deep periprosthetic infection, infection can persist after resection arthroplasty and treatment with antibiotics, leading to a failed second-stage reconstruction. Intraoperative analysis of frozen sections has been shown to have a high sensitivity and specificity for the identification of infection at the time of revision arthroplasty; however, the usefulness of this test at the time of reoperation after resection arthroplasty and treatment with antibiotics is, to our knowledge, unknown. METHODS: The medical records of sixty-four consecutive patients who had had a resection arthroplasty of either the knee (thirty-three patients) or the hip (thirty-one patients) and had had intraoperative analysis of frozen sections of periprosthetic tissue obtained at the time of a second-stage operation were reviewed. The mean interval between the resection arthroplasty and the attempted reimplantation was nineteen weeks. The results of the intraoperative analysis of the frozen sections were compared with those of analysis of permanent histological sections of the same tissues and with those of intraoperative cultures of specimens obtained from within the joint. The findings of the analyses of the frozen sections and the permanent histological sections were considered to be consistent with acute inflammation and infection if a mean of ten polymorphonuclear leukocytes or more per high-power field (forty times magnification) were seen in the five most cellular areas. RESULTS: The intraoperative frozen sections of the specimens from two patients (one of whom was considered to have a persistent infection) met the criteria for acute inflammation. Four patients were considered to have a persistent infection on the basis of positive intraoperative cultures or permanent histological sections. Overall, intraoperative analysis of frozen sections at the time of reimplantation after resection arthroplasty had a sensitivity of 25 percent (detection of one of four persistent infections), a specificity of 98 percent, a positive predictive value of 50 percent (one of two), a negative predictive value of 95 percent, and an accuracy of 94 percent. CONCLUSIONS: A negative finding on intraoperative analysis of frozen sections has a high predictive value with regard to ruling out the presence of infection; however, the sensitivity of the test for the detection of persistent infection is poor
— id: 56443, year: 1999, vol: 81, page: 684, stat: Journal Article,

Catastrophic failure of a cemented, collarless, polished, tapered cobalt-chromium femoral stem used with impaction bone-grafting. A report of two cases
Jazrawi LM; Della Valle CJ; Kummer FJ; Adler EM; Di Cesare PE
1999 Jun;81(6):844-847, Journal of bone & joint surgery (American volume)
— id: 6151, year: 1999, vol: 81, page: 844, stat: Journal Article,

Stability of press-fit acetabular cups
Adler E; Stuchin SA; Kummer FJ
1992 Sep;7(3):295-301, Journal of arthroplasty
Mechanical tests were performed to characterize the initial stability of press-fit cups as a function of cup design, surface structure, and surgical preparation. Eight cups from six manufacturers were press-fit into acetabular cavities prepared in two densities of Sawbones polyethylene foam and in bovine knee trabecular bone. Cavity sizes and cup loading forces were varied. Acetabular defects were simulated in the Sawbones model. Preparations were tested to determine axial-rotatory and tangential ('levering-out') stability. Results suggested that cup geometry and proper surgical technique--in particular, proper sizing and depth of the acetabular cavity--are important in determining initial cup stability independent of adjuvant screw or spike fixation. Stability is a function of the area of interface contact between the cup rim and the substrate. If the cavity is too small or too shallow, and the substrate too dense, the cup will not seat to the rim and stability will be compromised. If there are defects in the rim, the area of interface contact will be diminished and stability compromised. Cups with a true hemispherical design have a greater area of rim interface contact than 'low-profile' cups and are therefore more stable. 1 mm undersizing of the cavity (or 2 mm undersizing in less dense substrate) appears to provide optimal stability
— id: 65823, year: 1992, vol: 7, page: 295, stat: Journal Article,