RESUMEN
We have followed up for a period of seven to nine years 100 consecutive arthroplasties of the hip in which an entirely HA-coated implant had been used. The clinical results were excellent and bony incorporation was extensive in all components. No stem became loose or subsided but five cups were revised because of loosening after 3.8 to 5.5 years, having functioned painlessly and shown radiological ingrowth. Revision procedures because of excessive polyethylene wear have been performed on 18 hips and are planned for six more. Two eroded metal backings with worn-through polyethylene were exchanged; six hips showed metallosis without polyethylene wear-through. There were two cases of granulomatous cysts in the groin and 66 hips had osteolysis located periarticularly, in the greater trochanter or in the acetabulum.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Osteólisis/etiología , Acetábulo , Adulto , Anciano , Materiales Biocompatibles Revestidos , Femenino , Estudios de Seguimiento , Prótesis de Cadera/efectos adversos , Humanos , Hidroxiapatitas , Masculino , Persona de Mediana Edad , Osteoartritis de la Cadera/cirugía , Polietilenos , Diseño de Prótesis , Falla de PrótesisRESUMEN
We report the results of a 9-11-year clinical and radiographic follow-up of 27 Exeter prostheses in which cement pressurizing technique was employed. 3 stems fractured and 3 other stems and 1 cup underwent aseptic loosening. The remaining prostheses had satisfactory clinical and radiographic results. Stem subsidence was seen only as part of a loosening process. We suspect that the pronounced taper design is responsible for the poor results. While the slender and weak distal end is fixed in a thick cement mantle, the wide proximal part allows only a thin cement layer, easily subjected to mechanical disintegration. Proximal debonding increases both the stress on the distal part of the stem and the distal bone-cement interface shear stress. Hence, we believe that the same process underlies both the loosenings and the stem fractures. The presently employed Exeter stem is manufactured from the stronger Orthinox steel, which may diminish the risk for fracture, but it has retained the extreme taper design. It is not likely that a polished surface or improved cementing will prevent stem fracture. Therefore, one should still be concerned about late fractures of the Exeter stem.
Asunto(s)
Prótesis de Cadera , Anciano , Femenino , Fracturas del Fémur/diagnóstico por imagen , Fracturas del Fémur/etiología , Fémur/cirugía , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Falla de Prótesis , Radiografía , Factores de TiempoRESUMEN
We reconstructed in 24 patients, traumatic tissue loss in the foot with 10 lateral arm flaps and 14 scapular flaps. The mean follow-up was 4 (1-7) years. There was 1 flap loss, and 1 patient was amputated because of septic ankle arthrodesis. Healing with stable skin and scar was achieved in the remaining patients. Only patients with additional serious skeletal injury had reduced walking ability.
Asunto(s)
Traumatismos de los Pies , Pie/cirugía , Complicaciones Posoperatorias/cirugía , Colgajos Quirúrgicos/métodos , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Estudios de Seguimiento , Pie/fisiopatología , Marcha , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/fisiopatología , Reoperación , Cicatrización de HeridasRESUMEN
Thumb reconstruction following amputation was accomplished by microvascular transfer of the thumb from the contralateral paralyzed hand in two cases. The appearance and function of the transferred thumbs were excellent and no problem was seen in the donor hand.
Asunto(s)
Pulgar/lesiones , Pulgar/trasplante , Adulto , Amputación Traumática/cirugía , Humanos , Masculino , Parálisis/complicaciones , Trasplante Autólogo/métodosRESUMEN
We report 19 tibial fractures Types III B and C treated by free flaps. The fracture healed in 16 cases after 12 (3-54) months. In 3 cases a secondary amputation was carried out. Tibial malalignment or substantial shortening ensued in 1 case each. We conclude that coverage with free flaps, radical removal of dead bone, stable external fixation and transfer of vascularized bone may salvage the majority of Type III B and C tibial fracture with function superior to that after amputation.
Asunto(s)
Microcirugia/normas , Colgajos Quirúrgicos/normas , Fracturas de la Tibia/cirugía , Adolescente , Adulto , Amputación Quirúrgica/métodos , Amputación Quirúrgica/normas , Desbridamiento/métodos , Desbridamiento/normas , Femenino , Estudios de Seguimiento , Fijación de Fractura/instrumentación , Fijación de Fractura/métodos , Fijación de Fractura/normas , Curación de Fractura , Supervivencia de Injerto , Hospitales Públicos , Humanos , Masculino , Microcirugia/métodos , Persona de Mediana Edad , Noruega/epidemiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Valor Predictivo de las Pruebas , Pronóstico , Radiografía , Reoperación/estadística & datos numéricos , Terapia Recuperativa/métodos , Terapia Recuperativa/normas , Colgajos Quirúrgicos/métodos , Fracturas de la Tibia/clasificación , Fracturas de la Tibia/diagnóstico por imagenRESUMEN
We report a series of 32 free flap reconstructions following acute hand and forearm trauma. The series consists of two dorsalis pedis flaps, four scapular flaps and 26 lateral arm flaps. One flap became infected and failed completely, and a partial necrosis occurred in another flap. The transfers covered large skin defects, exposed tendons, tendon grafts, bone, bone grafts, joints, nerves and nerve grafts. The donor site morbidity was negligible. Our study shows that free microvascular flaps are a safe and convenient alternative to conventional flaps in hand surgery. The lateral arm flap seems very suitable for small and medium size defects.
Asunto(s)
Traumatismos del Antebrazo/cirugía , Traumatismos de la Mano/cirugía , Colgajos Quirúrgicos/métodos , Adolescente , Adulto , Anciano , Trasplante Óseo/métodos , Trasplante Óseo/patología , Niño , Femenino , Supervivencia de Injerto , Humanos , Masculino , Persona de Mediana Edad , Músculos/patología , Músculos/trasplante , Trasplante de Piel/métodos , Trasplante de Piel/patología , Transferencia Tendinosa/métodosRESUMEN
Twenty-six transfers of second toe to hand have been carried out in 25 cases. On 25 occasions the toe was anastomosed to the stump of the thumb, and in one to a metacarpal hand. Revascularization failed in five cases, but the remaining 21 healed with bony union occurring within six weeks in all cases. The mean follow up period was 52 months, range 14-81, and the results in 19 thumb cases were classified as excellent and in one as good by the Tamai score. We conclude that the microsurgical technique of transferring the second toe to the hand is challenging, but if revascularization is successful the functional results are good. Morbidity at the donor site is minimal.
Asunto(s)
Amputación Quirúrgica , Traumatismos de la Mano/cirugía , Pulgar/cirugía , Dedos del Pie/trasplante , Adolescente , Adulto , Anciano , Anastomosis Quirúrgica , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoAsunto(s)
Reimplantación/métodos , Pulgar/cirugía , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pulgar/irrigación sanguínea , Pulgar/lesionesRESUMEN
A prospective comparative study was made of patients in the age-group 60-79 years with osteoarthritis of the hip treated with the Müller total hip prosthesis (n = 155) and the ICLH double-cup prosthesis (n = 149). The patients were comparable with regard to sex, mean age, and body weight, and the preoperative radiographic appearance of the hips was th same in the two groups. The mean operating time was significantly shorter in the Müller group, whereas the operative blood loss and the operative complications were statistically equal. No deep infections occurred in either group. The incidence of systemic complications was low and no difference between the two groups was seen. The patients are followed up for an average of 48.5 months (range: 27-75 months). Dramatic improvement in hip function was seen postoperatively in both prosthetic groups. The Müller group had more favorable ratings than the ICLH group for pain, walking ability, hip motion, and total hip score at all follow-ups, from 3 weeks to 5 years after the operation. However, the differences were rather small and did not reach a significant level at any registration. The acetabular radiolucent zones and heterotopic bone formation were statistically equal in the two groups. No revision operations have been done in the Müller group. Two Müller prostheses have shown radiographic signs of mechanical loosening. Thirteen ICLH prostheses (8.7%)--all in female patients--have been reoperated (P less than 0.001), 12 owing to mechanical loosening and one because of pain and stiffness.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Prótesis de Cadera , Osteoartritis/cirugía , Anciano , Estudios de Evaluación como Asunto , Femenino , Fracturas de Cadera/etiología , Articulación de la Cadera/diagnóstico por imagen , Prótesis de Cadera/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Estudios Prospectivos , Diseño de Prótesis , Falla de Prótesis , Radiografía , ReoperaciónAsunto(s)
Reimplantación , Pulgar/cirugía , Adolescente , Adulto , Anciano , Humanos , Persona de Mediana Edad , PronósticoAsunto(s)
Antebrazo/cirugía , Reimplantación , Adolescente , Humanos , Masculino , Cicatrización de HeridasRESUMEN
Revision of 19 Müller total hip prostheses and 9 ICLH double-cup prostheses is compared. In the Müller group the mean operation time was 186 min, the amount of blood transfused 3526 ml, and the hospital stay 34.9 days. The corresponding figures for the ICLH group were 94 min, 1389 ml, and 25.7 days. Revision of the conventional hip prostheses involved technical difficulties and complications such as femoral fractures and postoperative dislocations, which were not seen in the ICLH group, in which the revision was as easy to perform as the primary operation. The clinical result 6 months after revision was significantly better in the ICLH group. Thus, the double-cup prosthesis provides another possibility for revision. However, a relatively high incidence of early loosening indicates that it should not be used in older patients in whom one would expect a follow-up shorter than the lifetime of a conventional hip prosthesis.