Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 2000
Reduction of fat embolic risks in total hip arthroplasty using cannulated awls and rasps for the preparation of the femoral canal.
Fat embolic phenomena during cemented and non-cemented total hip arthroplasty occur even during the preparation of the femoral canal. This should be avoided in order to reduce the rate of fat embolic syndrome. In the present prospective study we demonstrate the benefit of cannulated awls and rasps in the reduction of fat embolic phenomena by means of transoesophageal echocardiography and extended cardiopulmonary monitoring. ⋯ In contrast to these findings, three macroemboli and four embolic showers grades 1 and 3 were demonstrated in group 2. We recommend cannulated awls and rasps for the preparation of the femoral canal in cemented and non-cemented total hip arthroplasty. They are a simple and inexpensive aid to avoid fat embolic syndrome.
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Arch Orthop Trauma Surg · Jan 2000
The influence of obesity on perioperative morbidity and mortality in revision total hip arthroplasty.
The significance of obesity as a risk factor for postoperative complications was determined in a consecutive series of 229 cases of revision total hip replacement. The body mass index (BMI) was used as an objective measure to classify the patients. ⋯ The results of our study demonstrate a clear association between obesity and operative time, whereas no statistically significant relationships were observed between obesity and the other parameters. We conclude that obesity does not have any significant influence on perioperative morbidity and mortality but is clearly related to operation time and, therefore, to higher costs per operation.
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Arch Orthop Trauma Surg · Jan 2000
Loosening pattern in a cementless custom-made hip stem: X-ray analysis, finite-elements and photoelasticity measurements.
Thirty-three X-press cementless stems (Depuy) manufactured according to standardized X-rays were inserted from 1992 to 1994. The patients' mean age was 49 (range 15-79) years with a mean follow-up of 32 (+/-6) months. A characteristic radiographic pattern of aseptic loosening with erosion of the medial cortex by the tip of the stem occurred in 28 patients and a valgus shift of the implant in 14 cases. ⋯ The intertrochanteric fit and fill obviously resulted in an unfavorable distribution of contact areas, including peaks of high stress on the medial tip of the stem. These experimental findings are even evident for a postulated rotational stability. The clinical and radiographic results of the cementless X-press stems do not seem to support the fixation concept of intertrochanteric fit and fill of femoral components.
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Chondromyxoid fibroma is a benign, although potentially aggressive tumor, with a cartilage-like matrix, accounting for approximately 1% of all bone tumors. It usually affects the metaphyseal region of long bones of patients in their first or second decade of life. An additional peak of incidence has been observed between 50 and 70 years of age. ⋯ Preferred treatment is complete local excision with tumor-free margins. Intralesional curettage with or without local adjuvants shows a local recurrence rate of approximately 25%. Radiation therapy may be useful in nonresectable cases but bears the well documented risk of radiation-induced malignancies.
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We report here three fully documented cases of periosteal chondroma diagnosed and treated in our hospital. There have been few references since Lichtenstein first described this condition as a separate tumour, and none of them concerned children under 10 years old. deSantos accurately describes the radiological features of the tumour. ⋯ The study included a previous histological examination in two cases and a follow-up in all of them. From this study we learned that invasive diagnosis procedures are unnecessary as we could follow the behaviour and evolution of this cartilaginous benign tumour for a long period of time.