Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 2000
Comparative StudyMortality after total knee arthroplasty in patients with osteoarthrosis and rheumatoid arthritis.
Total knee arthroplasty (TKA) is a widely used procedure in the treatment of severe destruction of the knee joint because of osteoarthrosis (OA) or rheumatoid arthritis (RA). The aim of this study was to explore whether there is an increased mortality in patients after TKA with the underlying diagnosis OA or RA compared with the general population. We studied a consecutive series of 422 primary TKAs with a hinged Blauth prosthesis in 330 patients (OA: 208 patients, 175 women, 33 men; RA: 122 patients, 109 women, 13 men) with a mean follow-up of 6 years (range 0-20 years). ⋯ SMRs of patients suffering from RA showed a clear shortening of the life span (women: 2.92, 95% CI 2.17-3.85; men: 3.09, 95% CI 1.0-7.19). In spite of the risk of intra- and perioperative complications and further operative procedures necessary because of late complications, the implantation of a knee prosthesis per se does not necessarily significantly reduce the life expectancy in patients with OA. Patients with RA who require the implantation of a total knee prosthesis obviously represent a high-risk group with a high mortality rate.
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Arch Orthop Trauma Surg · Jan 2000
Operative or conservative treatment of the acutely torn anterior cruciate ligament in middle-aged patients. A follow-up study of 133 patients between the ages of 40 and 59 years.
In all, 133 patients with an acute rupture of the anterior cruciate ligament (ACL) were reviewed (aged 40 to 59 years). Average follow-up was 29 +/- 10 months. Thirty-one patients underwent conservative therapy, 35 patients were treated by primary suture, while in 67 the primary suture was augmented with the semitendinosus tendon. ⋯ There was no significant difference between the patients with augmented ACL repair and conservative treatment in the assessment of range of motion, while the patients with primary suture had a significantly greater loss of flexion than those in the other two treatment groups. Increasing age was not found to have a negative effect on either operative or conservative treatment. The results indicate that patients between the ages of 40 and 59 years can be treated successfully by ACL surgery.
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Arch Orthop Trauma Surg · Jan 2000
Comparative StudyThe saddle prosthesis in pelvic primary and secondary musculoskeletal tumors: functional results at several postoperative intervals.
The first purpose of this study was to evaluate the saddle prosthesis in patients with periacetabular tumors in terms of the functional results obtained after several postoperative intervals. The second purpose was to evaluate the complications and how they might be prevented in the future. Functional results according to the MSTS functional rating system were evaluated at several postoperative intervals in 15 patients treated with internal hemipelvectomy and reconstruction with the saddle prosthesis because of periacetabular primary (n = 9) or secondary (n = 6) malignancies. ⋯ Deep infection occurred in 4 patients and fracture of the iliac remnant in 2. Heterotopic ossifications along the interpositional component were seen in 5 patients, but they did not negatively influence the functional outcome. Three (relative) contraindications to reconstruction with the saddle prosthesis could be ascertained: osteoporosis, extended involvement of the iliac wing by tumor, and insufficient soft-tissue quality after previous procedures. (Short-term) functional results after reconstruction with the saddle prosthesis are satisfactory if the above-mentioned contraindications are taken into consideration.
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Arch Orthop Trauma Surg · Jan 2000
Case ReportsMorphologic and morphometric study of patellar resurfacing with woven carbon filamentous pads.
Analysis of retrieved woven carbon filamentous pads, used for resurfacing of the patellar joint surface, disclosed a 4-zonal organizational pattern. Zone 1, facing the articular cavity, was devoid of carbon filaments and consisted of fibrous tissue. Foreign body granulation tissue and fibrous tissue occupied about one-third and approximately 50%-60% of the interfilamentous space in zones 2 and 3, respectively. ⋯ The bone volume within the latter was approximately 25%. Given that the purpose of articular resurfacing with implants is repopulation of the defect by chondrocytes producing a cartilaginous matrix, the woven carbon filamentous pads did not fulfill this expectation. In an environment of an ongoing foreign body-induced granulomatous reaction, the stem cells permeating the interstices of the woven carbon filamentous pad are apparently incapable of maturing into highly differentiated cells (chondrocytes) synthesizing a highly complex (cartilaginous) matrix.
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We present the outcome of a mould arthroplasty implanted for a congenital hip dysplasia in 1955 to revise a previous cup arthroplasty. This type of prosthesis, which has been developed on the basis of the concept of Smith-Peterson, by Prof. Marino-Zuco in Rome in the early 1940s, showed excellent results and was widely used until the advent of Charnley low-friction arthroplasty.