Steven A Stuchin, M.D.

Coronary artery disease, aspirin, and perioperative myocardial infarction and bleeding in orthopedic surgery
Oberweis B.; Nukala S.; Rosenberg A.; Stuchin S.; Radford M.J.; Berger J.S.
2011 ;32:172-172, European heart journal
Purpose: Increasing numbers of patients with established coronary artery disease (CAD) are undergoing surgical procedures. Since patients with CAD are at increased risk for both thrombotic and bleeding complications during the perioperative state, the role of antiplatelet therapy in this setting remains elusive. We therefore sought to investigate the incidence of thrombotic and bleeding events, as well as to identify significant risk factors. Methods: For all 3295 knee, hip, and spine surgical procedures performed November 2008 - December 2009 at a tertiary care medical care center we determined the presence or absence of CAD, CAD risk factors, and post-operative myocardial infarction or hemorrhage using ICD-9 diagnosis codes. 3083 patients were found to be eligible for the study after 212 patients less than 21 years were excluded from the study. Transfusion data were ascertained from the blood bank. Perioperative aspirin use and troponin elevation were determined through retrospective medical record review for all 327 CAD cases. Results: Overall, the in-hospital incidence was higher in patients with CAD (n=327) versus without CAD (n=2756) for any troponin elevation (19.3% vs 4.2%, P<0.001), coded MI (2.1% vs 0.5%, P<0.001), >= 2 transfusions of packed red blood cells (33.6% vs 16.6%, P<0.001), and coded post-operative hemorrhage (2.1% vs 0.7%, P=0.01). Among patients with CAD, use of aspirin preoperatively was not associated with any troponin elevation (6.6% vs 13.2%, P=0.23) or >= 2 transfusion units (6.8% vs 9.7%, P=0.29). In fact, the use of aspirin in the preoperative state was associated with fewer coded MI's (7.5% vs 14.3%, P=0.05). Conclusions: Patients with CAD undergoing orthopedic surgery are at a significant risk for both ischemic and bleeding complications. A lower risk of MI was seen in patients with CAD who were on preoperative aspirin, yet, there was no increase in bleeding outcomes. Future prospective studies are needed to address the potential perioperative role of aspirin and the trade-off between ischemic and bleeding complications among surgical patients with CAD
— id: 137913, year: 2011, vol: 32, page: 172, stat: Journal Article,

Oblique posterior trochanteric osteotomy in revision total hip arthroplasty
Stuchin, Steven A; Millman, Jennifer S
2011 Apr;26(3):472-475, Journal of arthroplasty
Modular polyethylene failure and attendant revision play an increasing role in hip arthroplasty. In spite of well-fixed, well-aligned components, bearing exchange has a high risk of chronic instability, which may be attributed to the resection of stabilizing soft tissue structures to gain exposure. This creates a difficult situation for the surgeon and an inexplicable one for the patient with a previously well-functioning implant. The senior author modified a technique previously described by Shaw that included an osteotomy of the posterior one third of the greater trochanter and preservation of posterior soft tissues. Thirty-five patients underwent 47 revision procedures utilizing this approach, including 16 modular component and 31 more extensive procedures. There were no dislocations or significant complications and no loss of reduction or nonunion. The approach offers excellent exposure while preserving stabilizing soft tissues
— id: 132307, year: 2011, vol: 26, page: 472, stat: Journal Article,

Recurrent hemarthrosis in a hemophilic patient after revision total knee arthroplasty
Park, Justin J; Slover, James D; Stuchin, Steven A
2010 Oct;33(10):771-771, Orthopedics (Thorofare NJ)
Recurrent hemarthrosis following a revision total knee arthroplasty is a rare complication. The likelihood of encountering bleeding complications in patients with hemophilia C following major surgery is unpredictable. Although the use of postoperative chemotherapeutic agents to prevent deep venous thrombosis (DVT) is considered the standard of care for most patients, its use in the hemophiliac population is unknown. This case describes a woman with Hemophilia C who presented with recurrent hemarthrosis 9 days after her revision total knee arthroplasty. Initial treatment efforts were directed towards treating the patient's underlying coagulopathy. Repeated transfusions of fresh frozen plasma and desmopressin were given in an attempt to achieve hemostasis. However the hemarthrosis did not resolve and 36 days postoperatively, a pseudoaneurysm of the left superior geniculate artery was found by angiography and percutaneously embolized. This article presents the first case, to our knowledge, of recurrent hemarthrosis in a hemophiliac patient after revision total knee arthroplasty. It further highlights the importance of considering all possible causes of postoperative bleeding to make a timely diagnosis in the face of a confounding clinical picture
— id: 129373, year: 2010, vol: 33, page: 771, stat: Journal Article,

Extra-articular deformities and the role of hip resurfacing - a proposed classification system
Stuchin, Steven A
2009 ;67(2):135-137, Bulletin of the NYU Hospital for Joint Diseases
There has been an increasing demand for hip resurfacing as an alternative to total hip arthroplasty. A number of reports have been published recently detailing the technique and role of resurfacing in a variety of extra-articular deformities, dysplastic conditions, and settings of retained intramedullary hardware and other impediments. The following report proposes a classification system that recognizes intramedullary and extramedullary deformities. With the long-term expectation for resurfacing, these complex situations may require categorization to segregate risk factors in order to allow for better planning and prognostication
— id: 101121, year: 2009, vol: 67, page: 135, stat: Journal Article,

Anatomic diameter femoral heads in total hip arthroplasty: a preliminary report
Stuchin, Steven A
2008 Aug;90 Suppl 3:52-56, Journal of bone & joint surgery (American volume)
BACKGROUND: The stability of total hip replacements has been directly related to the diameter of the femoral head in several studies; however, durability has necessitated the use of femoral heads with a relatively small diameter. Recent developments in metal-on-metal technology have allowed for the use of femoral head bearings that are anatomic in diameter. In this case series, we report on the early results of patients who were at greater risk for dislocation because of anatomic deficiencies or increased range-of-motion activities and underwent hip arthroplasty with implants that had articulating surfaces approaching anatomic dimensions. METHODS: Thirty-four patients underwent forty total hip arthroplasties with use of a modular metal-on-metal articulation with an anatomic diameter femoral head and a press-fit stem. Thirty patients were active, and four patients were profoundly disabled and had bone or soft-tissue deficiencies that would increase the risk for dislocation. Dislocation precautions were maintained for six weeks, and patients were allowed extreme ranges of motion at three months. RESULTS: There were no dislocations. Active patients continued in extreme range-of-motion activities. Disabled patients improved but were limited by their comorbidities. CONCLUSIONS: Anatomic diameter femoral heads offer distinct theoretical advantages in total hip arthroplasty. These short-term results are encouraging, and further study of this new technology in a larger series with a longer follow-up period is warranted
— id: 81067, year: 2008, vol: 90 Suppl 3, page: 52, stat: Journal Article,

Protein isoprenylation regulates secretion of matrix metalloproteinase 1 from rheumatoid synovial fibroblasts: effects of statins and farnesyl and geranylgeranyl transferase inhibitors
Abeles, Aryeh M; Marjanovic, Nada; Park, Jean; Attur, Mukundan; Chan, Edwin S; Al-Mussawir, Hayf E; Dave, Mandar; Fisher, Mark C; Stuchin, Steven A; Abramson, Steven B; Pillinger, Michael H
2007 Sep;56(9):2840-2853, Arthritis & rheumatism
OBJECTIVE: To determine whether protein prenylation (farnesyl/geranylgeranylation) regulates matrix metalloproteinase (MMP) secretion from rheumatoid arthritis (RA) synovial fibroblasts (RASFs), and whether MMP-1 secretion can be regulated by statins or prenyltransferase inhibitors via effects mediated by ERK, JNK, and NF-kappaB. METHODS: RASFs obtained from patients during elective knee replacement surgery were assessed by immunoblotting and/or enzyme-linked immunosorbent assay for secretion of MMP-1 and MMP-13 in the presence of tumor necrosis factor alpha (TNFalpha), interleukin-1beta (IL-1beta), statins, the farnesyl transferase (FT) inhibitor FTI-276 and geranylgeranyl transferase inhibitor GGTI-298, and prenyl substrates (farnesyl pyrophosphate [FPP] and geranylgeranyl pyrophosphate [GGPP]). Activities of JNK and ERK were determined by phosphoimmunoblotting, and NF-kappaB activation was determined by nuclear translocation of the p65 component. RESULTS: FTI-276, but not statins, inhibited RASF secretion of MMP-1, but not MMP-13, following induction with TNFalpha (P = 0.0007) or IL-1beta (P = 0.006). Loading RASFs with FPP to promote farnesylation enhanced MMP-1 secretion. FTI-276 inhibited activation of JNK (P < 0.05) and NF-kappaB (P = 0.02), but not ERK. In contrast, GGTI-298 enhanced, while GGPP inhibited, MMP-1 secretion. FTI-276 and GGTI-298 together had no effect on MMP-1 secretion. Stimulation of RASFs with TNFalpha or IL-1beta led to increased expression and activity of FT. CONCLUSION: Protein farnesylation is required for expression and secretion of MMP-1 from RASFs, via effects on JNK and NF-kappaB. The ability of cytokines to stimulate the expression and activity of FT suggests that FT may be increased in the rheumatoid joint. In contrast, geranylgeranylation down-regulates MMP-1 expression. Statins simultaneously inhibit farnesylation and geranylgeranylation, and in consequence do not inhibit MMP-1 secretion. The ability of FTI-276 to inhibit MMP-1 secretion suggests a potential therapeutic strategy in RA
— id: 93879, year: 2007, vol: 56, page: 2840, stat: Journal Article,

Management of periprosthetic femur fractures with a first generation locking plate
Fulkerson, Eric; Tejwani, Nirmal; Stuchin, Steven; Egol, Kenneth
2007 Aug;38(8):965-972, Injury
Periprosthetic femoral fractures associated with well-fixed total hip or total knee prostheses present a challenging management problem as these injuries typically occur in osteoporotic bone. Conventional management entails extensive periosteal stripping to allow for plate fixation. We reviewed a consecutive series of patients who sustained fractures associated with a well fixed total knee prosthesis, a total hip prosthesis, or both. Twenty four patients with a mean age of 69.4 years were included. All patients underwent fixation via percutaneous insertion techniques with a first generation locking plate and screws (LISS-Less Invasive Skeletal Stabilization, Synthes, Paoli, PA). Three patients sustained fractures distal to a well-fixed total hip prosthesis, eighteen fractures occurred above a well-fixed total knee femoral component, and three were interprosthetic. The mean length of time from the index procedure to fracture was 76 months, range (2-172 months). Blood loss was minimal in each case, with a mean operative time of 90min (range 60-120min). Twenty one of twenty four went on to unite at a mean 6.2 months (range 3-19 months). Three patients underwent further surgery. One failure of fixation was encountered. Percutaneous fixation is technically demanding as it requires stable fixation without direct visualisation of the fracture site or the entire fixation device. Our results suggest percutaneous fixation with the LISS plate is an effective although technically demanding method of treatment. Complication rates were comparable to existing reports of this treatment method, and appear to be improved over traditional methods of fixation
— id: 73516, year: 2007, vol: 38, page: 965, stat: Journal Article,

MR imaging features of radial tunnel syndrome: initial experience
Ferdinand, Brett D; Rosenberg, Zehava Sadka; Schweitzer, Mark E; Stuchin, Steven A; Jazrawi, Laith M; Lenzo, Salvatore R; Meislin, Robert J; Kiprovski, Kiril
2006 Jul;240(1):161-168, Radiology
PURPOSE: To retrospectively assess magnetic resonance (MR) imaging features of radial tunnel syndrome. MATERIALS AND METHODS: Institutional review board approval was obtained, and informed consent was waived for the retrospective HIPAA-compliant study. MR images of 10 asymptomatic volunteers (six men, four women; mean age, 30 years) and 25 patients (11 men, 14 women; mean age, 49 years) clinically suspected of having radial tunnel syndrome were reviewed for morphologic and signal intensity alterations of the posterior interosseous nerve and adjacent soft-tissue structures. MR images of the asymptomatic volunteers were reviewed to establish the normal appearance of the radial tunnel. MR images of the symptomatic patients were evaluated for the following: signal intensity alteration and morphologic alteration of the posterior interosseous nerve; the presence of mass effect on the posterior interosseous nerve such as the presence of bursae, a thickened leading edge of the extensor carpi radialis brevis, or prominent radial recurrent vessels; signal intensity alteration within the depicted forearm musculature such as edema or atrophy; and signal intensity changes at the origin of the common extensor and common flexor tendons, which would suggest a diagnosis of epicondylitis. RESULTS: All images of volunteers demonstrated normal morphology and signal intensity within the posterior interosseous nerve and adjacent soft tissues. Two volunteers had borderline thickening of the leading edge of the extensor carpi radialis brevis. Thirteen patients (52%) had denervation edema or atrophy within muscles (supinator and extensors) innervated by the posterior interosseous nerve. One patient had isolated pronator teres edema. Seven (28%) patients had the following mass effects along the posterior interosseous nerve: thickened leading edge of the extensor carpi radialis brevis (n = 4), prominent radial recurrent vessels (n = 1), schwannoma (n = 1), or bicipitoradial bursa (n = 1). The rest of the patients had either normal MR imaging findings (n = 4) or lateral epicondylitis (n = 2). CONCLUSION: Muscle denervation edema or atrophy along the distribution of the posterior interosseous nerve is the most common MR finding in radial tunnel syndrome
— id: 66465, year: 2006, vol: 240, page: 161, stat: Journal Article,

Cementless porous-coated sockets without holes implanted with pure press-fit technique
Torga Spak, Roger; Stuchin, Steven A
2005 Jan;20(1):4-10, Journal of arthroplasty
We evaluated the use of a pure press-fit technique in 220 porous-coated acetabular components without screw holes at mean follow-up of 6.1 years (4-7.5 years). The socket had a 14 degrees enhanced gradient at the periphery and was underreamed by 1 to 2 mm depending on bone quality. The Harris Hip average score was 44.3 (26-70) preoperatively and 93.1 (66-100) at final follow-up. There were no postoperative gaps in any zone. Nonprogressive radiolucent lines were detected in 4 hips. There was no movement or migration of the acetabular component on the follow-up x-rays. Pelvic osteolysis was not observed. Whereas 5 cups (2.3%) had revisions, none was revised for aseptic loosening. The press-fit technique provides stability in appropriate cases avoiding the theoretical complications related to screws or screw holes
— id: 56174, year: 2005, vol: 20, page: 4, stat: Journal Article,

Postoperative management after total hip and knee arthroplasty
Youm, Thomas; Maurer, Steven G; Stuchin, Steven A
2005 Apr;20(3):322-324, Journal of arthroplasty
Despite major advances in the field of total joint arthroplasty, a standardized postoperative management protocol currently does not exist following total hip arthroplasty (THA) and total knee arthroplasty (TKA). A survey was mailed to the active members of the American Association of Hip and Knee Surgeons to investigate issues such as postoperative rehabilitation and activity restriction. The information derived from this survey provides the total joint surgeon with a compilation and consensus of responses that can serve as the foundation for a standardized postoperative protocol for THA and TKA surgery
— id: 56173, year: 2005, vol: 20, page: 322, stat: Journal Article,

Different surgical options for monocompartmental osteoarthritis of the knee: high tibial osteotomy versus unicompartmental knee arthroplasty versus total knee arthroplasty: indications, techniques, results, and controversies
Mont, Michael A; Stuchin, Steven A; Paley, Dror; Sharkey, Peter F; Parvisi, Javad; Tria, Alfred J Jr; Bonutti, Peter M; Etienne, Gracia
2004 ;53:265-283, Instructional course lectures (American Association of Orthopaedic Surgeons)
The decision of what procedure to perform for the treatment of monocompartmental osteoarthritis of the knee when nonsurgical treatment methods fail remains controversial. Recent advances using osteotomy, unicompartmental knee replacement, and total knee replacement have been reported. For example, there are new concepts for performing high tibial osteotomies rather than the traditional Coventry method. Many techniques now involve osteotomies below the tibial tubercle. Unicompartmental knee replacement can be done using a standard approach, but less invasive approaches exist, along with minimally invasive approaches for total knee replacement, rather than the standard large incision, that promote decreased soft-tissue destruction
— id: 73517, year: 2004, vol: 53, page: 265, stat: Journal Article,

Anterior knee pain due to biplanar rotatory malalignment of the femoral component in total knee arthroplasty. Case report
Torga-Spak, Roger; Parikh, Shital N; Stuchin, Steven A
2004 May;17(2):113-116, Journal of knee surgery
— id: 46190, year: 2004, vol: 17, page: 113, stat: Journal Article,

Sixteen-year follow-up of the cemented spectron femoral stem for hip arthroplasty
Issack, Paul S; Botero, Herman G; Hiebert, Rudi N; Bong, Matthew R; Stuchin, Steven A; Zuckerman, Joseph D; Di Cesare, Paul E
2003 Oct;18(7):925-930, Journal of arthroplasty
Clinical and radiographic follow-up was performed on a consecutive series of 105 patients who underwent 120 total hip arthroplasties at the authors' institution from 1983 to 1988 with a straight, cobalt-chrome femoral stem implanted using a second-generation cementing technique. The mean age at the time of surgery was 68.5 years, and the mean follow-up was 16 years. At 16 years' follow-up, the prevalence of revision for aseptic loosening of the Spectron femoral component was only 4.2%; 5 stems were revised for aseptic loosening at a mean of 10.2 years after implantation. Sixteen-year survivorship of the component was 93.9% +/- 2.7% when revision for aseptic loosening was taken as the endpoint or 90.3% +/- 4.4% when either revision for aseptic loosening or radiographic evidence of loosening was taken as the endpoint
— id: 44537, year: 2003, vol: 18, page: 925, stat: Journal Article,

Surgical management of the rheumatoid elbow
Kauffman, Jeffrey I; Chen, Andrew L; Stuchin, Steven; Di Cesare, Paul E
2003 Mar-Apr;11(2):100-108, Journal of the American Academy of Orthopaedic Surgeons
Many patients with rheumatoid arthritis demonstrate elbow involvement that may limit upper extremity function, usually within 5 years of disease onset. Initial management consists of nonsurgical measures that address synovitis and capsular inflammation in an effort to diminish pain and maintain elbow range of motion. Disease progression may result in articular damage and ligamentous compromise, causing increased symptoms, elbow instability, and functional debilitation. For patients unresponsive to nonsurgical management, open or arthroscopic synovectomy may provide relief of symptoms. For those with more advanced disease, elbow arthroplasty is a reasonable alternative. Advancements in prosthetic technology and surgical techniques allow elbow arthroplasty to be reliably performed in patients with severe rheumatoid arthritis of the elbow
— id: 73519, year: 2003, vol: 11, page: 100, stat: Journal Article,

The spectrum of prosthesis design for primary total knee arthroplasty
Mont, Michael A; Booth, Robert E Jr; Laskin, Richard S; Stiehl, James B; Ritter, Merrill A; Stuchin, Steven A; Rajadhyaksha, Amar D
2003 ;52:397-407, Instructional course lectures (American Association of Orthopaedic Surgeons)
Many types of prostheses are currently used for total knee arthroplasty. Controversy exists, however, regarding which prostheses are the most appropriate for use by individual surgeons and specific patient groups. Six types of prostheses are currently being used in the United States for primary total knee arthroplasty: posterior cruciate ligament-retaining prostheses; posterior cruciate ligament-substituting prostheses; prostheses with ceramic components; mobile-bearing prostheses; nonmodular, compression-molded polyethylene prostheses; and medial-pivot prostheses. The historical and current result of using these different types of prostheses are discussed, and the indications, contraindications, and recommendations for each type are delineated
— id: 73518, year: 2003, vol: 52, page: 397, stat: Journal Article,

Sleep apnea syndrome in patients undergoing total joint arthroplasty
Parikh, Shital N; Stuchin, Steven A; Maca, Cielo; Fallar, Eileen; Steiger, David
2002 Aug;17(5):635-642, Journal of arthroplasty
Sleep apnea syndrome (SAS) is a condition of repeated episodes of apnea and hypopnea during sleep. It can cause life-threatening morbidities, including cardiac arrhythmia and ischemia, hypertension, and respiratory arrest, and even death. In a retrospective study at our institution of patients who underwent hip or knee total joint arthroplasty (TJA) with a diagnosis of SAS, we hypothesized that avoiding factors that exacerbate SAS in the perioperative period would minimize adverse outcomes. There were 19 patients with a preoperative diagnosis of moderate or severe SAS; 15 patients received continuous positive airway pressure or bilevel positive airway pressure noninvasive ventilation, 1 patient experienced respiratory arrest secondary to intraoperative propafol, and 2 patients developed postoperative respiratory depression. Avoidance of opioids and sedative drugs, awareness of the possibility of acute airway obstruction, and close monitoring during and after surgery are vital in patients with SAS
— id: 73520, year: 2002, vol: 17, page: 635, stat: Journal Article,

Osteopontin: an intrinsic inhibitor of inflammation in cartilage
Attur MG; Dave MN; Stuchin S; Kowalski AJ; Steiner G; Abramson SB; Denhardt DT; Amin AR
2001 Mar;44(3):578-584, Arthritis & rheumatism
OBJECTIVE: To identify extracellular and intraarticular matrix components that are differentially expressed in normal and osteoarthritis (OA)-affected cartilage and to investigate their functions with respect to regulation of mediators of inflammation. METHODS: Differential-display reverse transcriptase-polymerase chain reaction (RT-PCR) analysis of a pool of messenger RNA (mRNA) from 10 human OA cartilage samples and 5 normal cartilage samples was performed using arbitrary primers. Confirmatory analysis of the up-regulated transcripts of fibronectin (FN) and osteopontin (OPN) was performed by RT-PCR of individual RNA samples from a separate set of donors. The effect of recombinant OPN (or anti-OPN antiserum) on chondrocyte function was examined by analyzing the spontaneous or interleukin-1 (IL-1)-induced release of nitric oxide (NO) and prostaglandin E2 (PGE2) from human OA-affected cartilage under ex vivo conditions. RESULTS: Up-regulation (300-700%) of FN and OPN mRNA was observed in human OA-affected cartilage as compared with normal cartilage. Functional analysis of the role of OPN in OA cartilage showed that 1) Addition of 1 microg/ml (20 nM) of recombinant OPN to human OA-affected cartilage under ex vivo conditions inhibited spontaneous and IL-1beta-induced NO and PGE2 production, and 2) neutralization of intraarticular OPN with anti-OPN antiserum augmented NO production. CONCLUSION: The data indicate that one of the functions of intraarticular OPN, which is overexpressed in OA cartilage, is to act as an innate inhibitor of IL-1, NO, and PGE2 production. These findings suggest that the production of pleiotropic mediators of inflammation that influence cartilage homeostasis, such as NO and PGE2, is regulated by the interaction of chondrocytes with differentially expressed proteins within the extracellular matrix
— id: 26765, year: 2001, vol: 44, page: 578, stat: Journal Article,

A novel technique for the removal of well-fixed, porous-coated acetabular components with spike fixation
Della Valle, CJ; Stuchin, SA
2001 DEC ;16(8):1081-1083, Journal of arthroplasty
The removal of well-fixed, porous-coated acetabular components at the time of revision total hip arthroplasty can be challenging. The presence of spike fixation can increase the difficulty of removing an acetabular component because traditional methods of component removal, such as the use of curved gouges, may not be possible. We report a novel technique for the removal of well-fixed, porous-coated acetabular components with adjunctive spike fixation. This technique uses an overlay template that targets the spikes for removal with a high-speed, carbide-tipped bur
— id: 54786, year: 2001, vol: 16, page: 1081, stat: Journal Article,

The effect of stem modularity and mode of fixation on tibial component stability in revision total knee arthroplasty
Jazrawi LM; Bai B; Kummer FJ; Hiebert R; Stuchin SA
2001 Sep;16(6):759-767, Journal of arthroplasty
The effect of stem length, diameter, and mode of fixation on the motion and stress transfer of a cemented tibial tray were evaluated for in 12 cadaver knees. There was a significant decrease in motion of the tibial tray with increasing press-fit stem length (75-150 mm) and increasing stem diameter (10-14 mm). Cemented tibial stems showed significantly less tray motion than uncemented stems. The short cemented stems produced tray stability equivalent to long press-fit stems. Although there was a trend for increased proximal tibial stress shielding with the use of cement and longer, wider stems, the trend was not statistically significant. Modular, press-fit stems can achieve tray stability similar to a smaller cemented stem and can avoid the potential problems with cement
— id: 26667, year: 2001, vol: 16, page: 759, stat: Journal Article,

Treatment of de Quervain's disease: Role of conservative management
Lane, LB; Boretz, RS; Stuchin, SA
2001 JUN ;26(3):258-260, Journal of hand surgery (British volume)
This retrospective study compares two methods used to treat de Quervain's disease: splintage with oral non-steroidal anti-inflammatory drugs (NSAIDs) and steroid injection, Patients were separated into three groups based on symptom severity: group I-minimal, group II-mild, and group m-moderate or severe, Three hundred and nineteen wrists in 300 patients were followed from one to six years, Fifteen of 17 patients with minimal symptoms were relieved with splintage and NSAIDs. However, only seven of 20 in Group II and two of eight in Group III treated similarly were relieved. Of the 249 patients in Group III treated with injections, 76% were completely relieved, 7% were improved, and 4% were not improved. We conclude that classification of patients' with de Quervain's disease based on their pre-treatment symptoms may assist surgeons in selecting the most efficacious treatment and in providing prognostic information to their patients
— id: 55025, year: 2001, vol: 26, page: 258, stat: Journal Article,

Gene discovery and functional genomics in human osteoarthritis: Upregulation of osteopontin in human-osteoarthritis affected cartilage and regulation of of nitric oxide and prostaglandin E2
Attur, MG; Dave, MN; Stuchin, SA; Kowalski, AS; Lopez, CA; Zhang, J; Abramson, SB; Denhardt, DT; Amin, AR
2000 APR 20 ;14(6):A1152-A1152, FASEB journal
— id: 54644, year: 2000, vol: 14, page: A1152, stat: Journal Article,

Anticoagulant treatment of thromboembolism with intravenous heparin therapy in the early postoperative period following total joint arthroplasty
Della Valle CJ; Jazrawi LM; Idjadi J; Hiebert RN; Stuchin SA; Steiger DJ; Di Cesare PE
2000 Feb;82(2):207-212, Journal of bone & joint surgery (American volume)
BACKGROUND: Treatment of thromboembolism with intravenous heparin therapy in the early postoperative period after total joint arthroplasty has been associated with a high rate of complications. The purpose of the present study was to compare the rate of bleeding complications in a group of patients who required intravenous heparin therapy for the treatment of thromboembolism after total hip or knee arthroplasty with the rate in a control group of patients who received only prophylactic anticoagulation. METHODS: The postoperative courses of forty-four consecutive patients who were managed with intravenous administration of heparin and oral administration of warfarin for the treatment of a thromboembolic event following unilateral total hip or knee arthroplasty were compared with those of a control group of 376 consecutive patients who had these same procedures but did not have a thromboembolic complication. The patients in the control group were managed with prophylactic anticoagulation with use of enoxaparin. Sixty-eight percent (thirty) of the forty-four patients in the heparin group received the initial dose of heparin on or before the fourth postoperative day, and 82 percent (thirty-six) received an initial bolus of 5000 units of heparin at the initiation of therapy. RESULTS: The rate of bleeding complications was 9 percent (four of forty-four) in the heparin group, compared with 6 percent (twenty-three of 376) in the control group (p = 0.44). The mean transfusion requirement in the heparin group (1.8 units of packed red blood cells) was significantly greater than that in the control group (0.8 unit) (p < 0.0001). Three of the four patients who had a bleeding complication while receiving heparin and warfarin had coagulation parameters that were substantially higher than recommended levels. The mean duration of hospitalization in the heparin group (fifteen days) was significantly longer than that in the control group (seven days) (p < 0.0001). CONCLUSIONS: The results of the present study suggest that the use of intravenous heparin therapy for the treatment of thromboembolism in the early postoperative period after total joint arthroplasty is associated with a rate of bleeding complications that is similar to that associated with the use of prophylactic anticoagulation with use of enoxaparin alone. One should expect an increased transfusion requirement and a longer duration of hospitalization for patients who require intravenous heparin therapy for the treatment of a thromboembolic event
— id: 32648, year: 2000, vol: 82, page: 207, stat: Journal Article,

Hip arthroplasty with a collared straight cobalt-chrome femoral stem using second-generation cementing technique: a 10-year-average follow-up study
Kale AA; Della Valle CJ; Frankel VH; Stuchin SA; Zuckerman JD; Di Cesare PE
2000 Feb;15(2):187-193, Journal of arthroplasty
Clinical and radiographic results of 116 patients who had undergone 132 hip arthroplasties at our institution from 1983 to 1988 with a collared cemented straight cobalt-chrome femoral stem using second-generation cementing technique were reviewed. Twenty hips in 20 patients who were part of the original cohort were lost to follow-up. Mean age at the time of surgery was 68.2 years. Mean radiographic follow-up was 9.6 years with a minimum follow-up of 5 years. Ten-year survivorship of the component was 96.5% with revision considered as an endpoint and 94.2% with either revision or radiographic loosening considered the endpoint. Three implants (2.3%) were revised for aseptic loosening at a mean of 8.1 years after implantation. One implant (0.8%) was revised for septic loosening at 10.5 years after surgery. Of the implants not revised, 1 showed evidence of circumferential bone-cement radiolucencies, and 1 had radiolucencies at the implant-cement interface. Five of the surviving femoral components (5.0%) showed focal areas of cystic osteolysis, and proximal femoral bone resorption under the collar was seen in 32 patients (31.7%). There were no cases of cement fracture or stem subsidence. The biomechanical and material properties of this stem combined with second-generation cementing technique look promising for long-term survivorship
— id: 44564, year: 2000, vol: 15, page: 187, stat: Journal Article,

Wear rates of ceramic-on-ceramic bearing surfaces in total hip implants: a 12-year follow-up study
Jazrawi LM; Bogner E; Della Valle CJ; Chen FS; Pak KI; Stuchin SA; Frankel VH; Di Cesare PE
1999 Oct;14(7):781-787, Journal of arthroplasty
A retrospective clinical and radiographic analysis was performed on 58 patients (60 hips; mean age at time of surgery, 45.2 years) at a minimum of 10-year follow-up (mean, 12.7 years) after total hip replacement using a ceramic-on-ceramic hearing total hip implant (Autophor, Smith and Nephew, Memphis, TN). Mean wear rate at final follow-up was 0.21 mim, averaging 0.016 mm/y. There were no cases of periprosthetic osteolysis in the acetabuulum or femur. For the unrevised components, there were 3 (5%) cases of protrusio acetabuli and 4 (7%) cases of acetabular component loosening. On the femoral side, 78.3% had distal pedestal formation, and 83% had greater than 2 mm implant-bone radiolucencies in more than 5 Gruen zones as a result of gross motion of the stem. Despite radiographic evidence of implant loosening, this hard bearing articulation functioned well in vivo for more than 12 years with remarkably low wear--approximately one tenth the rate reported for metal-on-polyethylene total hip bearings
— id: 30805, year: 1999, vol: 14, page: 781, stat: Journal Article,

A novel mechanism of action of chemically modified tetracyclines: inhibition of COX-2-mediated prostaglandin E2 production
Patel RN; Attur MG; Dave MN; Patel IV; Stuchin SA; Abramson SB; Amin AR
1999 Sep 15;163(6):3459-3467, Journal of immunology
Tetracyclines (doxycycline and minocycline) inhibit inducible NO synthase expression and augment cyclooxygenase (COX)-2 expression and PGE2 production. In contrast, chemically modified tetracyclines (CMTs), such as CMT-3 and -8 (but not CMT-1, -2, and -5), that lack antimicrobial activity, inhibit both NO and PGE2 production in LPS-stimulated murine macrophages, bovine chondrocytes, and human osteoarthritis-affected cartilage, which spontaneously produces NO and PGE2 in ex vivo conditions. Furthermore, CMT-3 augments COX-2 protein expression but inhibits net PGE2 accumulation. This coincides with the ability of CMT-3 and -8 to inhibit COX-2 enzyme activity in vitro. The action of CMTs is distinct from that observed with tetracyclines because 1) CMT-3-mediated inhibition of PGE2 production coincides with modification of COX-2 protein, which is distinct from the nonglycosylated COX-2 protein generated in the presence of tunicamycin, as observed by Western blot analysis and 2) CMT-3 and -8 have no significant effect on COX-2 mRNA accumulation. In contrast, CMT-3 and -8 do not inhibit COX-1 expression in A549 human epithelial cells at the level of protein and mRNA accumulation or modification of COX-1 protein. CMT-3 and -8 inhibit the sp. act. of COX-2 (but not COX-1) in cell-free extracts. These results demonstrate differential action of CMT-3 (Metastat) on COX-1 and -2 expression, which is distinct from other tetracyclines
— id: 48708, year: 1999, vol: 163, page: 3459, stat: Journal Article,

Surgical management of inflammatory arthritis of the adult hip and knee
Stuchin SA; Johanson NA; Lachiewicz PF; Mont MA
1999 ;48:93-109, Instructional course lectures (American Association of Orthopaedic Surgeons)
— id: 56413, year: 1999, vol: 48, page: 93, stat: Journal Article,

TNF-alpha convertase (TACE) from human arthritis-affected cartilage isolation of cDNA by differential display, expression of the active enzyme and regulation of TNF-alpha
Amin, AR; Patel, IR; Attur, MG; Patel, R; Stuchin, SA; Abagyan, R; Abramson, SB
1998 MAR ;46(3):226A-226A, Journal of investigative medicine
— id: 53499, year: 1998, vol: 46, page: 226A, stat: Journal Article,

Results of cemented metal-backed acetabular components: a 10-year-average follow-up study
Chen FS; Di Cesare PE; Kale AA; Lee JF; Frankel VH; Stuchin SA; Zuckerman JD
1998 Dec;13(8):867-873, Journal of arthroplasty
The clinical and radiographic results of 86 primary total hip arthroplasties performed in 74 patients from 1983 to 1987 with a cemented metal-backed acetabular component and a cemented collared straight femoral stem with a 32-mm head were reviewed at a mean follow-up of 10.1 years. Seven patients (9.2%) underwent acetabular component revision at a mean of 9.0 years after implantation; an additional 24 components (31.6%) demonstrated evidence of radiographic loosening, resulting in a total failure rate of 40.8%. Periacetabular radiolucencies were noted in Charnley zones at the following rates: 34.2% in zone I, 18.4% in zone II, and 27.6% in zone III. In addition, 18.4% and 38.2% of implants demonstrated evidence of migration and excessive polyethylene wear. Excessively vertical cup placement (>49 degrees inclination) at the time of initial arthroplasty was statistically correlated with polyethylene wear, implant migration, and fixation failure. A trend of increasing implant failure was also noted with decreasing polyethylene liner thickness. Periacetabular cement mantle thickness was not statistically correlated with subsequent component loosening or failure. Results of Kaplan-Meier survivorship analysis using revision as an endpoint showed 93.6% survivorship at 10 years and 88.4% at 12 years. The mean modified Harris hip scores were 46.9 preoperatively and 81.8 at final follow-up. The significant overall rates of radiographic loosening, migration, polyethylene wear, and implant revision confirm the suspected trend of increasing failure rates of cemented metal-backed acetabular components over time
— id: 6042, year: 1998, vol: 13, page: 867, stat: Journal Article,

TNF-alpha convertase enzyme from human arthritis-affected cartilage: isolation of cDNA by differential display, expression of the active enzyme, and regulation of TNF-alpha
Patel IR; Attur MG; Patel RN; Stuchin SA; Abagyan RA; Abramson SB; Amin AR
1998 May 1;160(9):4570-4579, Journal of immunology
A snake venom-like protease isolated by a differential display screen between normal and osteoarthritis (OA)-affected cartilage (designated as cSVP) has a cDNA sequence identical to TNF-alpha convertase enzyme (TACE). TACE shows the presence of an unknown prodomain, a cysteine switch, a catalytic domain, a zinc binding region, a disintegrin region, an EGF-like domain, a transmembrane domain, and a unique cytoplasmic region. A TACE construct harboring the signal + prodomain + catalytic region (TACE-SPCdeltaDETCy), expressed in baculovirus could cleave preferentially (approximately 12-fold) the TNF-specific peptide over the matrix metalloproteases peptide in vitro. This recombinant protein also cleaved the natural substrate GST-ProTNF-alpha to TNF-alpha (17 kDa) in vitro. The mRNA for TACE, which is broadly distributed and differentially expressed in a variety of human tissues, is up-regulated in arthritis-affected cartilage, but not normal cartilage. OA-affected cartilage also expressed TNF-alpha mRNA that was not detected in normal cartilage. The OA-affected cartilage (in explant assays) spontaneously released TNF-alpha and IL-8 in ex vivo conditions. Addition of TNF-alphaR fused to IgG Fc fragment (TNF-alphaR:Fc) in the presence or absence of soluble IL-1R (with which it acted additively) significantly attenuated the spontaneous/autocrine release of articular IL-8 in this assay. These experiments demonstrate a functional paracrine/autocrine role of TNF-alpha in OA-affected cartilage that may depend, in part, on up-regulated levels of chondrocyte-derived TACE
— id: 7737, year: 1998, vol: 160, page: 4570, stat: Journal Article,

Catastrophic failure of the acetabular component in a ceramic-polyethylene bearing total hip arthroplasty
Simon JA; Dayan AJ; Ergas E; Stuchin SA; Di Cesare PE
1998 Jan;13(1):108-113, Journal of arthroplasty
Recent research in total hip arthroplasty has focused on attempts to decrease wear at the femoral head-acetabulum articulation, to limit the production of debris that is believed to lead to osteolysis and prosthetic loosening. The use of ceramic-on-polyethylene bearing surfaces has been reported to produce lower wear rates and therefore may increase the life expectancy of the joint arthroplasty. Problems with this bearing have been reported to be due to ceramic femoral head fracture. Reported here are 2 cases of catastrophic failure of total hip arthroplasties, involving a ceramic femoral head, caused by failure of the polyethylene acetabular liner, with subsequent penetration of the femoral head through the acetabular shell
— id: 7794, year: 1998, vol: 13, page: 108, stat: Journal Article,

Superinduction of cyclooxygenase-2 activity in human osteoarthritis-affected cartilage. Influence of nitric oxide
Amin AR; Attur M; Patel RN; Thakker GD; Marshall PJ; Rediske J; Stuchin SA; Patel IR; Abramson SB
1997 Mar 15;99(6):1231-1237, Journal of clinical investigation
Cartilage specimens from osteoarthritis (OA)-affected patients spontaneously released PGE2 at 48 h in ex vivo culture at levels at least 50-fold higher than in normal cartilage and 18-fold higher than in normal cartilage + cytokines + endotoxin. The superinduction of PGE2 production coincides with the upregulation of cyclooxygenase-2 (COX-2) in OA-affected cartilage. Production of both nitric oxide (NO) and PGE2 by OA cartilage explants is regulated at the level of transcription and translation. Dexamethasone inhibited only the spontaneously released PGE2 production, and not NO, in OA-affected cartilage. The NO synthase inhibitor HN(G)-monomethyl-L-arginine monoacetate inhibited OA cartilage NO production by > 90%, but augmented significantly (twofold) the spontaneous production of PGE2 in the same explants. Similarly, addition of exogenous NO donors to OA cartilage significantly inhibited PGE2 production. Cytokine + endotoxin stimulation of OA explants increased PGE2 production above the spontaneous release. Addition of L-NMMA further augmented cytokine-induced PGE2 production by at least fourfold. Inhibition of PGE2 by COX-2 inhibitors (dexamethasone or indomethacin) or addition of exogenous PGE2 did not significantly affect the spontaneous NO production. These data indicate that human OA-affected cartilage in ex vivo conditions shows (a) superinduction of PGE2 due to upregulation of COX-2, and (b) spontaneous release of NO that acts as an autacoid to attenuate the production of the COX-2 products such as PGE2. These studies, together with others, also suggest that PGE2 may be differentially regulated in normal and OA-affected chondrocytes
— id: 9734, year: 1997, vol: 99, page: 1231, stat: Journal Article,

Synovectomy, radial head excision, and anterior capsular release in stage III inflammatory arthritis of the elbow
Lonner JH; Stuchin SA
1997 Mar;22(2):279-285, Journal of hand surgery (American volume)
A retrospective study was performed to analyze the results of elbow synovectomy, radial head excision, and anterior capsular release in 12 elbows in 11 patients with radiographic stage III inflammatory arthritis. The follow-up period averaged 6.1 years. Average flexion arc improved from 93 degrees (range, 80 degrees-110 degrees) to 116 degrees (range, 65 degrees-140 degrees), with flexion contracture improving 13 degrees. Total arc of forearm rotation increased from 95 degrees to 145 degrees. Ewald scores improved from an average of 37 to 84 points. Pain was eliminated or improved in all cases; functional improvement was noted in all patients. Serial postoperative radiographs showed no significant disease progression over time. These results suggest that combined synovectomy, radial head excision, and anterior capsular release effectively relieves pain and improves function in stage III inflammatory arthritis of the elbow
— id: 7204, year: 1997, vol: 22, page: 279, stat: Journal Article,

Osteoarthritis-affected cartilage spontaneously produces COX-2-derived prostaglandin E(2): Regulation by nitric oxide synthase
Amin, AR; Attur, M; Patel, RN; Thakker, GD; Marshall, PJ; Rediske, J; Stuchin, SA; Abramson, SB
1996 SEP ;39(9):1466-1466, Arthritis & rheumatism
— id: 52788, year: 1996, vol: 39, page: 1466, stat: Journal Article,

Prostaglandin E(2) (PGE(2)) is an inflammatory component in osteoarthritis-affected cartilage: The yin-yang regulation of nitric oxide synthase and cyclooxygenase-2
Amin, AR; Marshall, PJ; Attur, M; Vyas, P; DiCesare, PE; Stuchin, SA; Rediske, J; Abramson, SB
1996 MAR ;44(3):A292-A292, Journal of investigative medicine
— id: 52962, year: 1996, vol: 44, page: A292, stat: Journal Article,

Surgical maneuvers placing the sciatic nerve at risk during total hip arthroplasty as assessed by somatosensory evoked potential monitoring
Pereles, T R; Stuchin, S A; Kastenbaum, D M; Beric, A; Lacagnino, G; Kabir, H
1996 Jun;11(4):438-444, Journal of arthroplasty
The sciatic nerve in 52 hip arthroplasties was evaluated using intraoperative somatosensory evoked potentials (SSEPs). Twenty-nine of these cases involved the lateral transtrochanteric approach, and 23 involved the posterior approach. A total of 11 incidents of SSEP changes occurred in eight patients. Six episodes occurred during lateral retraction of the proximal femur, and three occurred during anterior retraction of the proximal femur. Tracings returned to baseline with prompt cessation of femoral retraction in each case. One SSEP change occurred in a revision following reduction of the prosthetic components, and this resolved with shortening of the prosthetic neck to less than anatomic length. One change occurred during tightening of cables securing strut allografts to the femur and this resolved spontaneously. No correlation was found between frequency of SSEP changes and age, sex, limb lengthening, or preoperative range of motion. It is concluded that routine lateral or anterior retraction may place the sciatic nerve at risk
— id: 131563, year: 1996, vol: 11, page: 438, stat: Journal Article,

The expression and regulation of nitric oxide synthase in human osteoarthritis-affected chondrocytes: evidence for up-regulated neuronal nitric oxide synthase
Amin AR; Di Cesare PE; Vyas P; Attur M; Tzeng E; Billiar TR; Stuchin SA; Abramson SB
1995 Dec 1;182(6):2097-2102, Journal of experimental medicine
Classically, osteoarthritis (OA) has been considered a noninflammatory disease. However, the detection of selected inflammatory mediators in osteoarthritic fluid, in the absence of significant inflammatory cell infiltrate, is increasingly appreciated. We sought to identify the inflammatory component in human OA-affected cartilage that may be involved in cartilage damage/destruction. Using Western blot analysis and an antibody to the conserved region of nitric oxide synthase (NOS), we have observed up-regulation of NOS, one of the 'key players' of inflammation, in chondrocytes of OA-affected patients. Remarkably, none of the cartilage samples examined from normal joints demonstrated detectable amounts of this NOS. Western blot analysis using the same alpha-NOS antibody indicated that this NOS from OA-affected cartilage (OA-NOS) was larger in size than (and distinct from) transfected human hepatocyte or murine inducible NOS (iNOS) (150 versus 133 kD) and similar in size to neuronal constitutive NOS (ncNOS). Antibodies specific for iNOS showed binding to murine and human iNOS but not to OA-NOS, endothelial constitutive NOS, or ncNOS. Antibodies specific for ncNOS bound to ncNOS and also to OA-NOS, but not to murine or human iNOS or endothelial constitutive NOS. Incubation of OA cartilage in serum-free medium resulted in spontaneous release, for up to 72 h, of substantial amounts of nitrite (up to approximately 80 microM/100 mg wet tissue), which could be inhibited by at least 80% with various inhibitors of iNOS, including inhibitors of protein synthesis and transcription factor NF-kappa B, but which (unlike murine macrophage iNOS) was not sensitive to hydrocortisone or TGF-beta. Exposure of OA-affected cartilage to interleukin 1 beta, tumor necrosis factor-alpha, and lipopolysaccharide resulted in approximately 20-50% augmentation of nitrite accumulation, which was also sensitive to cycloheximide and pyrrolidine dithiocarbamate. Hence, our data indicate that OA-NOS (based on immunoreactivity and molecular weight) is similar to ncNOS and that it releases nitric oxide, which may contribute to the inflammation and pathogenesis of cartilage destruction in OA
— id: 9739, year: 1995, vol: 182, page: 2097, stat: Journal Article,

HUMAN OSTEOARTHRITIS-AFFECTED CHONDROCYTES SPONTANEOUSLY RELEASE NITRIC-OXIDE BY AN INDUCIBLE NEURONAL NITRIC-OXIDE SYNTHASE (OA-NOS) - A NEW TARGET FOR PHARMACOLOGICAL INTERVENTION
AMIN, AR; DICESARE, PE; VYAS, P; ATTUR, M; TZENG, E; BILLIAR, TR; STUCHIN, SA; ABRAMSON, SB
1995 SEP ;38(9):63-63, Arthritis & rheumatism
— id: 86685, year: 1995, vol: 38, page: 63, stat: Journal Article,

The effectiveness of cut-proof glove liners: cut and puncture resistance, dexterity, and sensibility
Salkin JA; Stuchin SA; Kummer FJ; Reininger R
1995 Nov;18(11):1067-1071, Orthopedics (Thorofare NJ)
Five types of commercial glove liners (within double latex gloves) were compared to single and double latex gloves for cut and puncture resistance and for relative manual dexterity and degree of sensibility. An apparatus was constructed to test glove-pseudofinger constructs in either a cutting or puncture mode. Cutting forces, cutting speed, and type of blade (serrated or scalpel blade) were varied and the time to cut-through measured by an electrical conductivity circuit. Penetration forces were similarly determined with a scalpel blade and a suture needle using a spring scale loading apparatus. Dexterity was measured with an object placement task among a group of orthopedic surgeons. Sensibility was assessed with Semmes-Weinstein monofilaments, two-point discrimination, and vibrametry using standard techniques and rating scales. A subjective evaluation was performed at the end of testing. Time to cut-through for the liners ranged from 2 to 30 seconds for a rapid oscillating scalpel and 4 to 40 seconds for a rapid oscillating serrated knife under minimal loads. When a 1 kg load was added, times to cut-through ranged from 0.4 to 1.0 second. In most cases, the liners were superior to double latex. On average, 100% more force was required to penetrate the liners with a scalpel and 50% more force was required to penetrate the liners with a suture needle compared to double latex. Object placement task times were not significantly liners compared to double latex gloves. Semmes-Weinstein monofilaments, two-point discrimination, and vibrametry showed no difference in sensibility among the various liners and double latex gloves. Subjects felt that the liners were minimally to moderately impairing. An acclimation period may be required for their effective use
— id: 65818, year: 1995, vol: 18, page: 1067, stat: Journal Article,

Technique for removal of femoral components with intercondylar articulation in total knee arthroplasty
Alpert SW; Stuchin SA; Lubliner JA
1993 95;53(4):48-49, Bulletin (Hospital for Joint Diseases)
Total knee revision arthroplasty is a challenging and demanding procedure. Removal of well-fixed implants must be done meticulously to preserve bone stock. The presence of intercondylar geometries compounds this problem because the cement-metal interface is inaccessible. The authors present a new technique for approaching this region using a high speed metal cutting burr, thus effectively preserving bone stock in the distal femur
— id: 23122, year: 1993, vol: 53, page: 48, 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,

Wrist anatomy
Stuchin SA
1992 Nov;8(4):603-609, Hand clinics
The multiple joints within the wrist form a complex structure capable of transmitting significant loads to the upper extremity while providing a mobile base for the precision movements of the hand. This duality is accomplished through a fine interplay between the carpal bones and an arrangement of highly specific ligamentous structures, a system loaded by balanced muscle forces
— id: 13370, year: 1992, vol: 8, page: 603, stat: Journal Article,

PATTERNS OF GENE ACTIVATION IN SYNOVIAL FIBROBLASTS AND WHOLE SYNOVIAL TISSUE OBTAINED FROM PATIENTS WITH INFLAMMATORY AND NON-INFLAMMATORY SYNOVITIS
RITCHLIN, C; DWYER, E; STUCHIN, S; BUCALA, R; LEE, H; CHAN, G; WINCHESTER, R
1991 APR ;39(2):A341-A341, Clinical research
— id: 51619, year: 1991, vol: 39, page: A341, stat: Journal Article,

Analysis of removed autophor ceramic-on-ceramic components
Kummer FJ; Stuchin SA; Frankel VH
1990 Mar;5(1):28-33, Journal of arthroplasty
Six Autophor alumina ceramic total hip arthroplasty components (5 removed for stem loosening and 1 for cup loosening) were evaluated to determine the nature and extent of wear by direct measurement, scanning electron microscopy of wear debris, and histology. Component implantation averaged 29 months (range, 8-54 months). All components had evidence of marked wear, including gross loss of material, which increased with the duration of implantation
— id: 65832, year: 1990, vol: 5, page: 28, stat: Journal Article,

Polyethylene bearing component failure and dislocation in the triaxial elbow. A report of two cases
Matarese W; Stuchin SA; Kummer FJ; Zuckerman JD
1990 Dec;5(4):365-367, Journal of arthroplasty
Two cases of polyethylene bearing failure in the Triaxial elbow are presented. Although these were low-demand patients with the prostheses properly aligned, the severity of the wear suggests inadequate prosthesis design
— id: 44615, year: 1990, vol: 5, page: 365, stat: Journal Article,

THE MANAGEMENT OF VASCULAR INJURIES ASSOCIATED WITH TOTAL HIP- ARTHROPLASTY
Shoenfeld, NA; Stuchin, SA; Pearl, R; Haveson, S
1990 Apr;11(4):549-555, Journal of vascular surgery
— id: 32086, year: 1990, vol: 11, page: 549, stat: Journal Article,

Technical note: a modified Harris trochanteric reattachment technique
Stuchin SA; Kummer FJ; Hanono SD
1988 Spring;48(1):102-104, Bulletin of the Hospital for Joint Diseases Orthopaedic Institute
A trochanteric reattachment technique which does not penetrate the femoral canal with wire has been developed for use in revision surgery or with press-fit implants. This technique was shown by in vitro mechanical testing to be comparable in stability to the standard Harris trochanteric reattachment method. It has been used successfully in 15 clinical cases
— id: 65840, year: 1988, vol: 48, page: 102, stat: Journal Article,

Accurate determination of limb length during total hip arthroplasty
Moskovich R; Stuchin S
1986 Spring;46(1):63-67, Bulletin of the Hospital for Joint Diseases Orthopaedic Institute
The authors present a method they have devised to measure limb length intraoperatively in total hip replacement using readily available operating room materials
— id: 35861, year: 1986, vol: 46, page: 63, stat: Journal Article,

Stiffness of small-bone external fixation methods: an experimental study
Stuchin SA; Kummer FJ
1984 Sep;9(5):718-724, Journal of hand surgery (American volume)
A variety of small-bone external fixation methods were evaluated to determine bending and torsional stiffness. Several methods of external pin stabilization with bone cement and with a commercial device were used. Among experimental variables examined were: the number of pins, pin diameter, pin length, pin spacing, and pin threading. The most rigid fixation was achieved with four pins held with a wire-reinforced bone cement fixator. Pin diameter was the most significant variable in the determination of stiffness with this configuration
— id: 65846, year: 1984, vol: 9, page: 718, stat: Journal Article,