Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 2000
Is there still an indication for operative treatment of femoral neck fractures with a ceramic hemiprosthesis? Four-year results.
From 1985 to 1995, 417 patients with dislocated medial femoral neck fractures (Garden III-IV) were treated with hemiarthroplasty using a Biolox ceramic head. The average patient age at the time of operation was 81.5 years. ⋯ At the time of follow up, 5 patients had severe hip pain, and in 8 the roentgenographic examination revealed protrusio acetabuli. Five of these 8 patients underwent revision surgery for replacement of the cup, leaving the stem in situ.
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Arch Orthop Trauma Surg · Jan 2000
Comparative StudyBigger size and defatting of bone chips will increase cup stability.
Morcellised bone allograft in an in vitro model was used to test the tendency towards cup rotation using small or larger fragment sizes of an impacted graft bed and different fat contents. A cup cemented on an impacted graft bed of larger sized bone chips from the Howex bone mill containing natural marrow fat was loaded eccentrically until the cup rotated. ⋯ The smaller sized bone chips from the Tracer bone mill defatted in a similar manner required only 1950 N for cup rotation. The conclusion was that larger sized chips, partly defatted, prevent rotation of a cup cemented on a graft bed.
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Arch Orthop Trauma Surg · Jan 2000
Cemented femoral impaction bone grafting for severe osteolysis in revision hip arthroplasty. Good results at 4-year follow-up of 10 patients.
Ten hips underwent impaction bone grafting with cement as revision of the femoral stem for severe osteolysis. At clinical follow-up of a median of 4 years (range 3.0-4.6 years) there were no failures. The median Harris hip score increased from 53 to 80, and pain score from 25 to 40. ⋯ All of the 9 patients with radiographical follow-up of more than 1 year showed trabecular remodelling, 7 of whom had signs of cortical repair. Subsidence was a median of 2 mm, with the maximum subsidence being 5 mm. The results appeared clinically stable after 4 years with radiographic reconstitution of the bone stock.
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Arch Orthop Trauma Surg · Jan 2000
Comparative StudyHistological and microbiological findings in non-infected and infected revision arthroplasty tissues. The OSIRIS Collaborative Study Group. Oxford Skeletal Infection Research and Intervention Service.
An assessment of clinical and laboratory findings is generally required to distinguish between septic and aseptic loosening of a hip implant. In order to evaluate the diagnostic utility of histological and microbiological investigative techniques to differentiate between these two conditions, we analysed their results in 617 patients with hip implant loosening. Histology and microbiology study confirmed the clinical diagnosis of septic loosening in approximately 98% and 89%. respectively. ⋯ In all but 2 of 81 cases of septic loosening, in which an organism was isolated on microbiological culture, the histological diagnosis of septic loosening was made on the basis of the degree of the acute inflammatory infiltrate (i.e. the presence of 1 or more neutrophil polymorphs per high power field (x 400) on average after examination of at least 10 high power fields) in periprosthetic tissues. In 10 patients for whom there was a strong clinical suspicion of septic loosening but no organisms were isolated on microbiological culture, the histological findings, using the above criteria, were in keeping with the clinical diagnosis of septic loosening. As almost 11% of cases of septic loosening would not have been diagnosed by microbiological investigation alone, our findings indicate that histological examination of periprosthetic tissues should form part of the investigative protocol to distinguish between aseptic and septic loosening.
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Arch Orthop Trauma Surg · Jan 2000
Late sciatic nerve palsy following avulsion of the biceps femoris muscle from the ischial tuberosity.
A case of late sciatic nerve palsy following avulsion of the biceps femoris muscle from the ischial tuberosity in a 27-year-old athlete is reported.