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Biomedical subjects

D H Sochart

Publications and source records attributed to D H Sochart.

34 records · Page 2Linked to original sources
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↗
PubMed1996

Role of ultrasound assessment and harness treatment in the management of developmental dysplasia of the hip.

The effect of the introduction of a programme combining clinical hip screening supplemented by limited targeted ultrasound assessment on splintage for developmental dysplasia of the hip (DDH) was evaluated over a 3-year period. The use of ultrasound is of both diagnostic and therapeutic value as it allows monitoring of the effects of splintage and decreases the total treatment time required. In all, 82 dysplastic hips were identified in 65 infants and the period of splintage averaged 6.3 weeks (range 3-12 weeks). The overall splintage rate can also be reduced as hips with only minor dysplasia can be assessed by serial scans until resolution or progression occurs rather than automatic treatment of all abnormal hips and in this series the rate was 6 per 1000 (0.6%). The Wheaton-Pavlik harness is a dynamic light-weight splint which is user friendly, easy to apply and adjust, and with no major complications being encountered in this series. Unnecessary exposure to radiation was reduced as plain radiographs were not performed before ossification of the capital epiphysis; prolonged splintage was prevented and a weaning period from the brace was not used. All children remained under follow-up for 1 year after the hips were confirmed to be clinically and radiologically normal and there were no cases of late re-dislocation or subluxation. There were no cases of avascular necrosis and a markedly reduced need for diagnostic arthrograms, with only two being performed during the 3 years. This regimen has resulted in a low rate of late presenting DDH requiring surgery of 0.28/1000, as well as a low splintage rate of 6/1000 (0.6%). Most of the improvement in the results can be attributed to the more accurate evaluation of DDH by ultrasound, but the absence of avascular necrosis and other complications is likely to be due to the shorter period of time spent in a dynamic splint without the use of excessive abduction.

Female↗
PubMed1995

A new osteotome for performing chevron trochanteric osteotomy.

We report on the use of a new modified osteotome for performing chevron trochanteric osteotomy during hip arthroplasty. It is easy to use and the apex of the chevron is directed distally, thus producing a large segment of osteotomized trochanter, while avoiding the problems of fragmentation and splintering. At the end of the procedure, the trochanter is easily seated back within its concave bed, automatically achieving anatomical reduction and allowing easier fixation using the cruciate wiring technique. In a series of 77 primary hip arthroplasties, bony trochanteric union was achieved within 6 months in all patients.

Femur↗
PubMed1994

Bilateral patellar tendon disruption--a professional predisposition?

A healthy 37-year-old male carpet fitter sustained an injury to both knees while playing football. The clinical signs of patellar tendon disruption were not obvious because of gross skin thickening as a result of his profession, however, the diagnosis was confirmed by ultrasound scan.

Adult↗