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Biomedical subjects

D H Sochart

Publications and source records attributed to D H Sochart.

At least 19 recordsLinked to original sources
PubMed1998

Poor results following internal fixation of displaced subcapital femoral fractures: complacency in fracture reduction.

The results following internal fixation of displaced subcapital femoral fractures are poorer than for undisplaced fractures and are determined by both the quality of the initial reduction and the accuracy of implant placement. In a series of 26 consecutive displaced fractures internally fixed with Richards hip pins, satisfactory reduction was achieved in only 15 hips. Accurate reduction is a prerequisite for correct screw placement and occurred in only 4 of the 11 poorly aligned fractures, as opposed to 11 of the 15 well reduced ones. A total of 10 hips required a further surgical procedure as the result of complications. These results highlight the importance of accurate fracture reduction in facilitating implant placement as well as the importance of good surgical technique rather than reliance purely upon the implant. These already common fractures are assuming increasing socioeconomic importance as the elderly population grows, and successful management is vital for both the individual patient and future demands on the health service.

Adult↗
PubMed1998

Failure of the spiral blade module of the AO unreamed femoral nail.

The treatment of subtrochanteric femoral fractures remains difficult despite the introduction of modern intramedullary nailing techniques. Accurate fracture reduction, correct siting of the proximal entry point and restoration of medial support remain essential for a successful outcome. We report a case of failure of the spiral blade module of the AO unreamed femoral nail, which may have been precipitated by incorrect siting of the entry point, resulting in poor implant positioning within the femoral head.

Accidental Falls↗
PubMed1998

Long-term results of cemented Charnley low-friction arthroplasty in patients aged less than 30 years.

The results of cemented Charnley low-friction arthroplasty in patients aged less than 30 years are presented. Eighty-three arthroplasties were performed on 55 patients with an average age of 24.9 years (range, 17-29 years) and an average follow-up period of 240 months (20 years; range, 62-360 months). There were 2 nonfatal pulmonary emboli, 2 cases of deep sepsis, and 3 fractured femoral implants. Twenty-eight acetabular components migrated (34%), 25 have been revised (30%), and the average annual acetabular wear rate was 0.12 mm. Sixteen femoral implants subsided (19%), and fracture of the tip of the cement mantle occurred in 8 hips (10%). Nineteen femoral components (23%) were revised; femoral osteolysis was seen in 15 hips (18%) and changes in the calcar in 33 (38%). Acetabular component survivorship was 92% (95% confidence interval, 85-98%) at 10 years, 70% (60-81%) at 20 years, and 68% (57-79%) at 25 years, with the figures for the femoral implant being 93% (87-98%), 76% (66-86%), and 73% (62-85%), respectively.

Adolescent↗
PubMed1998

Comparison of the Wrightington FC hip with the Charnley low-friction arthroplasty. 10- to 15-year results and survival analysis.

Between 1981 and 1986 two groups of patients received either Charnley low-friction arthroplasties or the Wrightington Frusto-Conical hip replacement with otherwise identical management before and after operation. There were 260 consecutive replacements in 215 patients in the first group and 260 consecutive procedures in 211 patients in the second. Both components of each design were cemented and featured a 22.25 mm femoral head, but the geometry of the stems differed. Of the patients lost to follow-up, 16 (18 hips) were in the Wrightington series and 24 (36 hips) in the Charnley series, and of those who have died 20 (23 hips) were Wrightington and 14 (16 hips) were Charnley. All surviving patients have been followed up clinically and radiologically or until revision was necessary. The mean length of follow-up for original surviving components in both series was 140 months (120 to 180). Pain, function and movement were measured by the grading system of Merle D'Aubigné and Postel and showed a marked improvement in both groups. There was little or no pain in 98% of patients in the Wrightington series and 96% in the Charnley series, while 93% and 85%, respectively, were entirely painfree. Trochanteric osteotomy was used in 292 cases overall, with a complication rate of 13% due to wire breakage, trochanteric bursitis or trochanteric detachment, requiring a further operation in 5.8% (17 hips). Heterotopic ossification was seen in 40% of cases in which trochanteric osteotomy had been performed (117 hips) but only 3% (10 hips) had clinically significant changes. After the direct lateral approach heterotopic ossification was seen in 24% (42 hips) with only 2% in class 3 or 4 (4 hips). Femoral osteolysis was more common in the Charnley series, occurring in 7.6% of cases (17 hips) as opposed to 2.1% (5 hips) in the Wrightington series. Ten acetabular and seven femoral components have been revised in the Wrightington series and 16 acetabular and 11 femoral implants in the Charnley series. Survivorship based on revision for aseptic loosening using the Kaplan-Meier technique showed survival of the femoral implant at 5, 10 and 15 years of 100%, 99% and 98%, respectively in the Wrightington and 100%, 99% and 87% in the Charnley series. The survival of the acetabular component at 10, 12 and 15 years respectively, was 100%, 99% and 95% for the Wrightington, and 99%, 98% and 84% for the Charnley. The survival of both the acetabular and femoral components of the Wrightington system at a mean of 11.7 years was better than that of the Charnley system, with a lower incidence of radiological loosening of unrevised components.

Acetabulum↗
PubMed1997

Improving the results of ganglion aspiration by the use of hyaluronidase.

We present the results of a prospective randomized trial comparing the treatment of ganglia by aspiration under local anaesthetic and either instillation of steroid alone or with the prior use of hyaluronidase. Thirty-five patients were treated in each group and followed up for 2 years. The cure rate with the combined use of hyaluronidase and methylprednisolone was 89%, compared to 57% when treated by aspiration and instillation of methylprednisolone alone.

Administration, Topical↗
PubMed1997

Carpal tunnel decompression under local anaesthetic and tourniquet control.

A postal survey within the North West Region (UK) revealed that 66% of the consultant orthopaedic surgeons did not use local anaesthesia routinely for carpal tunnel decompression. This prospective study was set up to assess the effectiveness, safety and patient tolerance of performing this procedure using local anaesthesia and upper arm tourniquet control. Eight-six carpal tunnel decompressions were performed on 75 consecutive and unselected patients with confirmed carpal tunnel syndrome over a 6-month period. Completed questionnaires were obtained before discharge. None or only slight discomfort was experienced for all aspects of the operation in at least 94%. None of the patients reported severe and unbearable discomfort. At review, 3 months postoperatively, all patients with the exception of two reported complete resolution of preoperative symptoms. The use of local anaesthesia and a tourniquet is safe, effective and well-tolerated in carpal tunnel decompressions.

Adult↗
PubMed1997

Nonsurgical management of supracondylar fracture above total knee arthroplasty. Still the nineties option.

Supracondylar fracture of the femur above a total knee arthroplasty has been reported to occur in 0.3-2.5% of all cases. The case of a patient who sustained such a fracture subsequent to a fall and whose fracture was managed without surgery with a good result is reported. There was no evidence of coexisting loosening, osteolysis, or significant wear, and satisfactory bony reduction was achieved, maintaining correct alignment of the prosthetic components. Healing occurred in 3 months, and the patient remains under follow-up evaluation with a painless knee and a range of movement similar to prefracture levels with no evidence of implant loosening. Despite the current enthusiasm for internal fixation of these fractures, a review of the current literature revealed that neither conservative nor operative management has a significant proven advantage, and the treatment of these difficult and uncommon fractures remains challenging. Nonoperative treatment of fractures above well-fixed components can, however, be as successful as surgical intervention, and remains a viable first-line approach. Conservative management also lacks the potential risks of operation, while maintaining the option of later surgical intervention if required.

Accidental Falls↗
PubMed1997

Infarction of a vertebral pedicle causing acute spinal cord compression.

We present a case of acute spinal cord compression due to haemorrhage following recurrent infarction of the right pedicle of the second lumbar vertebra. Such a case has not previously been reported and we describe the radiological and operative findings. Magnetic resonance imaging was particularly helpful in precisely localizing the lesion and planning surgery. The most likely diagnosis remained a solitary neoplastic deposit until confirmation of recurrent infarction was made on histological examination of the operative specimen. The histological findings were also in keeping with the episodic progression of the patients symptoms.

Acute Disease↗
PubMed1997

Long-term results of total hip replacement in young patients who had ankylosing spondylitis. Eighteen to thirty-year results with survivorship analysis.

We determined the long-term results of total hip replacement in a series of young patients who had ankylosing spondylitis. Between 1966 and 1978, forty-three Charnley low-friction arthroplasties were performed in twenty-four patients who had an average age of 28.8 years (range, nineteen to thirty-nine years) at the time of the operation. There were seventeen men and seven women. The average duration of follow-up for the series was 22.7 years (range, one month [a perioperative death] to 30.3 years). Four patients (seven hips) had died an average of 12.6 years (range, one month to 18.7 years) after the operation. The twenty surviving patients had clinical and radiographic follow-up until the time of writing or until both of the original components had been revised. All patients had substantial relief of pain and improvement of function and the range of motion of the joint. Twenty-one patients (88 per cent; thirty-nine hips) were completely free of pain (6 points, according to the scale of Merle d'Aubigne and Postel), and the remainder had only slight discomfort (5 points). Ten acetabular components and one femoral component were revised because of aseptic loosening, and one patient had a revision of both components because of late deep infection. Three additional femoral components were revised during a revision operation for a loose acetabular component. Although the femoral components were not loose, they had been in place for more than ten years and it was thought likely that the bearing surface was damaged. The average time to revision was 13.3 years (range, 4.0 to 20.3 years). At an average of 22.7 years, thirty-eight (88 per cent) of the original femoral components and thirty-two (74 per cent) of the original acetabular components remained in situ. The average annual rate of acetabular wear was 0.12 millimeter for the entire series. Only six hips (14 per cent) had minor heterotopic ossification, and none of the hips had clinically important ossification (class III or IV according to the system of Brooker et al.). To our knowledge, the present report describes the largest series of total hip arthroplasties, with the longest duration of follow-up, in young patients who had ankylosing spondylitis. Survivorship analysis with use of the Kaplan-Meier method revealed that the probability of survival of the femoral component (with 95 per cent confidence intervals) was 91 per cent (83 to 99 per cent) at twenty years and 83 per cent (72 to 94 per cent) at thirty years. The probability of survival of the acetabular components was 73 per cent (61 to 84 per cent) at twenty years and 70 per cent (57 to 83 per cent) at thirty years. The probability that both components would survive was 91 per cent (82 to 100 per cent) at ten years, 73 per cent (61 to 84 per cent) at twenty years, and 70 per cent (57 to 83 per cent) at thirty years. The Charnley low-friction arthroplasty provided consistently good long-term results, with a low rate of complications and revisions, in this group of young patients.

Adult↗
PubMed1997

The long-term results of Charnley low-friction arthroplasty in young patients who have congenital dislocation, degenerative osteoarthrosis, or rheumatoid arthritis.

We present the long-term results of 226 Charnley low-friction arthroplasties that were performed with use of cement in 161 patients between 1966 and 1978. Forty-four patients (sixty hips) had congenital dislocation of the hip, fifty-four patients (sixty-six hips) had degenerative osteoarthrosis, and sixty-three patients (100 hips) had rheumatoid arthritis. There were 114 female patients and forty-seven male patients. The average age of the patients at the time of the operation was 31.7 years (range, seventeen to thirty-nine years). Sixty-five patients (40 per cent) had a bilateral hip replacement. Thirty-eight patients (24 per cent; fifty-five hips), twenty-seven of whom had juvenile-onset chronic rheumatoid arthritis, died during the follow-up period. The average duration of follow-up for the entire series until the time of death, revision of both components, or the latest evaluation was 236 months (19.7 years; range, twenty-four to 361 months). Survivorship analysis was performed with the Kaplan-Meier method. At twenty-five years, the survival of the femoral component (with 95 per cent confidence intervals) was 89 per cent (80 to 98 per cent) in the patients who had congenital dislocation of the hip, 85 per cent (77 to 93 per cent) in the patients who had rheumatoid arthritis, and 74 per cent (61 to 87 per cent) in the patients who had degenerative osteoarthrosis. The rate of survival of the acetabular component was lower: at twenty-five years, it was 58 per cent (42 to 74 per cent) in the patients who had congenital dislocation, 79 per cent (70 to 88 per cent) in the patients who had rheumatoid arthritis, and 59 per cent (41 to 77 per cent) in the patients who had degenerative osteoarthrosis. The forty-four patients (sixty hips) who had congenital dislocation had the highest rates of aseptic loosening (twenty-two hips; 37 per cent), migration (seventeen hips; 28 per cent), and revision (twenty-two hips; 37 per cent) of the acetabular component. The fifty-four patients (sixty-six hips) who had degenerative osteoarthrosis had the highest rates of aseptic loosening (seventeen hips; 26 per cent) and revision (eighteen hips; 27 per cent) of the femoral component as well as the highest rate of femoral endosteal lysis (thirteen hips; 20 per cent). The sixty-three patients (100 hips) who had rheumatoid arthritis had the lowest prevalences of loosening and revision of the acetabular component but the highest rates of trochanteric non-union (fifteen hips; 15 per cent) and mortality (twenty-seven patients; 43 per cent). The average rate of wear of the acetabular component for the entire series was 0.11 millimeter per year; the average rate for the revised components (0.19 millimeter per year) was higher than that for the surviving components (0.09 millimeter per year). This was a consistent finding in each of the three diagnostic groups, and an increased annual rate of wear was found to be significantly associated with increased rates of migration and revision of the acetabular component (p < 0.01 for both). The femoral component proved to be durable: the twenty-five-year rate of survival for the entire series was 81 per cent (95 per cent confidence interval, 76 to 87 per cent). The major factors that limited the longevity of the cemented total hip implants in the present study were wear, loosening, and revision of the acetabular component, for which the twenty-five-year probability of survival was 68 per cent (95 per cent confidence interval, 61 to 75 per cent).

Acetabulum↗
PubMed1996

Arthroscopic portals: the importance of blade selection.

Arthroscopy of the knee is a commonly performed procedure with a low reported complication rate. We have experienced two cases during which no. 15 scalpel blades disengaged from the handle and remained within the joint. Although both the blades were successfully retrieved arthroscopically without injury to the knee, the procedures were prolonged, and there remained a potential risk of causing damage. We have subsequently altered our practice and now routinely use a no. 11 blade, with which we have had no complications. We discuss the importance of correct blade selection and surgical technique in avoiding this complication and present two illustrative case histories.

Adult↗