Zeitschrift für Orthopädie und Unfallchirurgie
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With the help of a clinical and radiological follow-up evaluation 8 years after implantation of the femoral neck prosthesis CUT (ESKA Implants, Lübeck Germany), the question of whether this metaphyseal anchoring implant is recommendable in young patients will be answered. ⋯ The analysis of the eight-year follow-up of 82 CUT prostheses shows that the implant does not fulfil our expectations of a femoral neck prosthesis, in spite of the possibility of a less invasive and bone-saving implantation technique. In view of unacceptable survival rates, valgisation changes of the joint geometry and critical changing procedures, from our point of view the femoral neck prosthesis CUT does not represent a recommendable alternative implant in young, active patients.
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Several non-fusion technologies have been developed as an alternative to fusion procedures in the past decades, in order to avoid typical problems related to fusion. The Dynesys (Zimmer, USA), which was inaugurated 7 years ago, consists of pedicle screws, flexible spacers and cords and is intended to control segmental motion and to realign the lumbar spine. Since this device is new, it was the goal of this study to analyse the perioperative morbidity of lumbar stabilisation with Dynesys retrospectively. ⋯ The perioperative morbidity of lumbar stabilisation with Dynesys seems to be similar to posterior fusion techniques. However, an additional morbidity due to interbody fusion, which may necessitate also autogenous bone, is avoided.
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Lumbar spinal canal stenosis is a common disease of the elderly patient, with a high prevalence and clinical importance. MRI is the established method of choice for the imaging of spinal canal stenosis. However, there is often a discrepancy between the clinical symptoms and the spinal canal stenosis as shown using MRI in a supine position. In such cases preoperative functional imaging is often warranted. ⋯ Using upright MRI a functional spinal canal stenosis can be shown. The pathomechanisms of the spinal canal stenosis are discussed. The possibilities and limitations of this new imaging modality are presented and analysed.
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Comparative Study
[Results after replacement of femoral neck prostheses - thrust plate prosthesis (TPP) versus ESKA cut prosthesis].
The aim of this study was to analyse and evaluate comparatively loosening mechanisms, failure frequency, surgical changing strategies and results after replacement of thrust plate prostheses (TPP) and ESKA Cut prostheses. ⋯ In comparison with the usually problem-free changing procedure of the TPP to a standard type stem, the revision surgery of the Cut prosthesis becomes substantially more complex and leads frequently to complications. In view of unacceptable survival rates, the Cut prosthesis does not represent an alternative implant in young patients. Except for the implantation technique, which does not allow a less invasive surgical procedure, the TPP fulfils the requirements of femoral neck prosthesis due to acceptable survival rates and good convertibility.
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Correction of severe tibial deformity due to a non-union of the tibia is best achieved by a slow gradual correction which allows the compromised tissue to adapt. The Taylor spatial frame (TSF) is a hexapod-based ring fixator that allows a simultaneous gradual correction of a multiplanar deformity through a virtual hinge. The aim of this study was to demonstrate the application of the TSF and the clinical outcomes of ten patients with a non-union of the tibia. ⋯ In patients with either a hypertrophic or oligotrophic non-union of the tibia and severe deformity, the TSF is a powerful tool to correct the deformity in a closed manner which preserves the remaining viability of the non-union.