In objection to knee hinge prostheses there is often mentioned a higher complication rate. An increased load impact on the bone-cement interface results from the close connection of tibial and femoral components. This is assumed to cause bad results, as reported from early artificial knee joint replacements, characterised by weight bearing axes and direct contact metal to metal. These are contrasted to long term results of the Blauth hinge prosthesis. The Blauth prosthesis is constructed according to the low friction principle without a weightbearing axis. A prospective multicentric long term follow-up study reports on 556 prostheses. 463 (83%) were controlled between 1 and 15 years after operation (average: 43 months). Aseptic loosenings had to be confirmed in 1.3% of the patients, deep infections in 2.6%. The survival analysis did not show an erratic deterioration in dependence of the observation period. After 10 years there is still a probability of 89% that a prosthesis does not show a deep infection or loosening. The efficiency of artificial knee joint replacement by hinge joints should therefore not be judged on the results of the first generation of these models.

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[Patellar changes during long-term observations on the Blauth knee joint endoprosthesis].

Changes in the position and structure of the patella and their importance with regard to pain patterns are described on the basis of long-term observation of the Blauth prosthesis. Examinations were performed on 206 knee prostheses on average 37.6 months (min. 12, max. 120 months) after implantation. Axial roentgenograms showed the patella to be laterally subluxated in 12% of the cases, and luxated in one. Also in 12% of the cases, osteolytic destruction of the posterior surface of the patella was found; there was a statistically significant correlation between the two groups, but they were not identical. In cases with changes in the patellar structure, initial pain on walking was significantly more frequent, though this was not so in cases where the kneecap had shifted from its normal position. The authors discuss possible connections with curvature radii and with the distances between the center of rotation and the sliding support on the femoral part of the prosthesis as causes of increased complaints in low kneecaps and for the increased incidence of structural changes in high kneecaps. The term "retropatellar pain syndrome" is applied to patients who experience pain when climbing stairs, rising from chairs and when starting to walk, in whom at least 2 of these complaints are positive: A total of 10.2% of the patients complained of considerable retropatellar pain. A patellectomy was performed in 8 of these patients. The radiological and histological analyses of 3 of the patellae removed showed evidence of arthrosis deformans at different stages, with concomitant synovitis.

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Patients' recollections of critical care.

Warm, caring, competent critical care nurses who communicate respect for patients' dignity and individuality alleviate fear and stress of a critical care unit stay. Patients perceive these nurses as professionals who deliver quality care. When cared for by critical care nurses with these characteristics, patients' satisfaction with care is heightened. This article provides an insight to patients' responses concerning their care in a critical care unit.

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As we see it. Beyond traditional service, Part II.

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