Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 2000
Comparative StudyBipolar versus total hip endoprosthesis: functional results.
Some functional parameters of the hip-joint 3.3 years on average (range 2-8.6 years) after hip arthroplasty are compared with regard to two types of hip endoprostheses: the total (TEP) and the bipolar (BPEP). Flexion, extension, abduction, adduction, and internal and external rotation were measured for 75 patients with BPEP type Self-Locking, for 11 patients with BPEP type Vario-Cup, and for 43 with TEP type Lubinus. ⋯ It was found that flexion, abduction and adduction were significantly higher in the BPEP endoprosthesis (P < 0.05). The results obtained are favourable for the bipolar hip endoprosthesis, and they can be related to the biomechanical differences between both types of hip endoprosthesis.
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Arch Orthop Trauma Surg · Jan 2000
Case ReportsAutogenous bone marrow graft to non-ossifying fibroma with a pathologic fracture.
Non-ossifying fibroma with a pathological fracture of the radius in a 10-year-old girl was successfully treated by curettage and autogenous bone marrow graft. The lesion was completely replaced by normal bone at 1 year after the operation. Autogenous bone-marrow graft was considered to be a useful method for the treatment of non-ossifying fibroma with minimal morbidity of the graft-harvesting site.
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Arch Orthop Trauma Surg · Jan 2000
Transtrochanteric rotational osteotomy for osteonecrosis of the femoral head with preoperative superselective angiography.
A prospective radiologic and scintigraphic study was made of 15 joints in 12 patients who underwent transtrochanteric rotational osteotomy of the femoral head after identifying by preoperative superselective angiography which arteries should be preserved during surgery. The preoperative superselective angiography revealed that the blood supply to the femoral head was provided by the medial femoral circumflex artery in 12 joints and a branch of the internal iliac artery in 3 joints. ⋯ At the follow-up examination made after at least 2 years, there were no cases of collapse of the new femoral head weight-bearing site, and also there were no cases with a large cold area in the femoral head on the scintigram obtained 2 months postoperatively. For this operative procedure, the nutrient arteries of the femoral head should be confirmed by preoperative superselective angiography, and it is essential that these arteries be preserved during surgery.
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Arch Orthop Trauma Surg · Jan 2000
Comparative StudyHyaluronan in synovial fluid of patients with loose total hip prosthesis. Comparison with hyaluronan in patients with hip osteoarthritis and idiopathic osteonecrosis of femoral head.
The concentration and molecular weight of hyaluronan (HA) in the synovial fluid of the hip joint were determined in 13 patients (aged 62.8 +/- 9.4 years) who had undergone prior total hip arthroplasty(THA), 23 patients (aged 65.0 +/- 8.2 years) with osteoarthritis of the hip joint (OA), and 13 patients (aged 40.2 +/- 2.7 years) with idiopathic osteonecrosis of the femoral head (ION). A sample of synovial fluid was obtained during revision THA because of loosening of the total hip prosthesis for the THA group, and during the first replacement surgery or osteotomy for the OA and ION groups. The concentration of HA in the synovial fluid was 0.64 +/- 0.42 mg/ml in the THA group, 1.07 +/- 0.28 mg/ml in the OA group, and 1.30 +/- 0.56 mg/ml in the ION group. ⋯ The molecular weight of HA was 309 +/- 88.3 x 10(4) Da in the THA group, 377 +/- 201 x 10(4) Da in the OA group, and 240 +/- 148 x 10(4) Da in the ION group; these values do not differ significantly (P = 0.259 vs OA, P = 0.174 vs ION). Among the THA patients, there was no relation between the concentration of HA and the age of the patient, length of time since the first operation, or type of prosthesis fixation; there was also no relation between the molecular weight of HA and each of these factors. These results suggest that a pseudosynovial membrane is regenerated after THA, and that it produces HA of the same molecular weight as that in patients with OA and ION, although in smaller quantities.
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Arch Orthop Trauma Surg · Jan 2000
Case ReportsNon-tuberculous cold abscess of the psoas muscle--an unusual manifestation of colocutaneous fistula.
We report here a case of colocutaneous fistula drained from the retroperitoneal space mimicking a cold abscess of the psoas muscle. A 60-year-old diabetic woman with a 6-year history of a chronic draining sinus over her right thigh had been treated intermittently with antibiotics. At presentation, she had no systemic toxic signs nor other constitutional symptoms. ⋯ After the correct diagnosis of colocutaneous fistula, right nephrectomy and right hemicolectomy with ileotransverse colostomy were done. The patient was well 5 years later without recurrence. This is an atypical presentation of enterocutaneous fistula in an immunodeficient patient that should be emphasized to facilitate the correct diagnosis and early treatment.