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Biomedical subjects

E Elmstedt

Publications and source records attributed to E Elmstedt.

18 recordsLinked to original sources
PubMed2002

Patient expectation and satisfaction in revision total hip arthroplasty.

Sixty-six consecutive revision total hip arthroplasty patients were asked about their expectations regarding future pain and walking ability. Expectations were high, regardless of background factors: 92% expected to have much less pain, and 82% expected the same walking ability as after the primary arthroplasty or a much improved walking ability. Of the patients, 56% stated a non-surgeon-related origin of expectations, 7% were uncertain, and 37% said expectations derived from the surgeon. At 1 year, Harris hip score had increased from a median 45 to 77 points, but only 69% and 55% said that their expectations had been fulfilled to a very large or rather large extent regarding pain and walking ability. The only predictor of fulfilled expectations was absence of complications (odds ratio, 4.8; 95% confidence interval, 1.1-20.8). Patient satisfaction was only moderate; 63% were very or rather satisfied with a moderate correlation (0.46-0.47) between satisfaction and fulfilled expectations. Patients with a poor preoperative hip condition generally were more satisfied (odds ratio, 5.0; 95% confidence interval, 1.4-17.9), and the most important reason probably was an improved walking ability (r = 0.64). Patient dissatisfaction may originate from unrealistic expectations. At preoperative consultation, it is recommended that the surgeon discuss the revision patient's expectations, especially regarding future walking ability, and inform the patient about the fundamental prognostic differences between revision and primary hip arthroplasty.

Aged↗
PubMed2001

Ultrasound for diagnosis of infection in revision total hip arthroplasty.

Eighty consecutive patients (85 hips; 43 women; median age, 74 years [range, 33-90 years]) underwent a revision total hip arthroplasty. Preoperatively and guided by ultrasound, biopsy specimens of the joint pseudocapsule were taken, and joint fluid was aspirated for culture. Capsule morphology was investigated with light microscopy. When septic loosening was defined as 2 intraoperative cultures yielding the same microorganism, the prevalence was 12%. Sensitivity of the capsule biopsy cultures was 67%; specificity, 68%; positive predictive value, 22%; and negative predictive value, 94%. Joint fluid was often sparse and always falsely sterile. One specimen from a hip with septic loosening showed histologic changes (> or =3 foci, each with > or =3 plasma cells/high-power field) consistent with chronic infection. The remaining 8 septic loosenings eluded histologic detection, yielding 11% sensitivity. All aseptic loosenings were classified correctly (specificity 100%). Positive and negative predictive values were 100% and 89%. Ultrasound-guided aspiration and capsule biopsy with cultures and histology does not seem to be sufficiently accurate in the preoperative diagnosis of infected total hip arthroplasty.

Adult↗
PubMed2001

Early loosening of the stemmed McMinn cup.

The stemmed McMinn cup was used in 26 acetabular reconstructions (median age, 59 [range, 33-85 years]; 21 women) at 5 orthopaedic centers in Sweden between 1995 and 1998. Of the patients, 24 (92%) had severe bone defects (Gustilo-Pasternak grade 3 and 4). At a clinical and radiographic follow-up of median 3 years (range, 1-5 years), 4 (17%) cups were rerevised at 1 (2 cups), 2, and 3 years owing to symptomatic aseptic loosening. Another 8 cups (40%) were radiographically definitely loose and 1 (5%) was probably so. With an overall mechanical failure rate (rerevised plus definitely loose devices) of 43.8% at a minimum 3-year follow-up, the stemmed McMinn cup does not seem to be a reliable solution in acetabular reconstruction.

Acetabulum↗
PubMed2000

Revision total hip arthroplasty using third-generation cementing technique.

A total of 83 consecutive first-revision total hip arthroplasties were performed in 83 patients using pressurized vacuum-mixed cement, a third-generation cementing technique. At a median follow-up of 3.6 years (range, 1.5-6.3 years), the overall failure rates (radiographic loosening, re-revision, or both) were 39% for the femoral components and 30% for the acetabular components. With definite radiographic loosening as an endpoint, the cement-bone interface achieved was the only significant factor to predict stem durability, with an adjusted odds ratio of 1.8 (95% confidence interval, 1.1-3.0). On the acetabular side, bone stock was the only significant factor, with an adjusted odds ratio of 5.3 (95% confidence interval, 4.0-27.7). In this retrospective cohort study, femoral cement pressurization per se did not appear to improve the results over those of other studies using second-generation techniques.

Adult↗
PubMed1988

Foot deformities in the newborn--incidence and prognosis.

In a consecutive screening of 2,401 newborn, a foot deformity was noted in 100 of the infants (4.2 percent). At follow-up 5-6 years later, the children with a foot deformity were reexamined and compared with normal controls. Seventy-six infants had some adduction deformity of the foot at birth. At reexamination, 87 percent of the examined children had normal feet. No association was observed between sleeping prone and the presence of adduction deformity at the reexamination. Pes calcaneovalgus was diagnosed in 18 newborn. Of those reexamined, all had normal feet. Up to the age of 6 years, 4.3 percent of the 2,401 had been referred to the department of orthopedics because of a foot deformity; 50 because of an adduction deformity, and in 10 of these children the deformity was observed at birth. The investigation indicates that no treatment is required for pes calcaneovalgus or adductus deformity confined to the forefoot.

Child, Preschool↗
PubMed1986

Fracture incidence and bone disease in epileptics receiving long-term anticonvulsant drug treatment.

Of 155 institutionalized epileptics, 16 (10%) were noted to have suffered from different kinds of fractures when observed over a period of 1 year. The patients with fractures were further investigated with respect to blood and urine chemistry and bone morphology. The serum and urinary calcium values were below the average values for the population. Elevated values for serum alkaline phosphatase and for immunoreactive parathyroid hormone were found in most patients. The values of serum phosphate were distributed close to those of the normal population, while the urinary phosphate values were lower. Examination of bone biopsies revealed a significantly increased amount of osteoid and a significantly increased osteoclastic resorptive activity in epileptics, compared with age-matched controls. Furthermore, a slightly diminished volume of trabecular bone was noted. The high incidence of fractures may be explained by bone disease--a combination of osteoporosis, osteomalacia, and hyperparathyroidism due to chronic treatment with anticonvulsant drugs.

Anticonvulsants↗
PubMed1985

Effect of ibuprofen on heterotopic ossification after hip replacement.

A double-blind, placebo-controlled study was made of the influence of the anti-inflammatory agent ibuprofen on heterotopic ossification after total hip replacement for arthrosis, fracture or rheumatoid arthritis. Seven drop-outs left 21 patients on medication and 22 on placebo in two comparable groups. Heterotopic ossification appeared in one third of the patients in the ibuprofen group and in three fourths in the control group 12 months after surgery. Five patients in the latter group developed true heterotopic bone, compared to one of the patients on medication. Heterotopic ossification was as common among osteoarthritic patients as among others. There was no difference in the range of motion at 12 months postoperatively between patients with and without heterotopic ossification. In the 22 patients with heterotopic ossification this was demonstrated in all but eight within 6 weeks, and in only three did it appear later than 3 months postoperatively. Five of the six patients who showed heterotopic bone with trabecular structure were male. Since inflammation is a dominant feature in the postoperative phase, the effect of ibuprofen on heterotopic ossification is probably its inhibition of the synthesis of prostaglandins. This implies that prevention is most successful if commenced before or at the time of operation.

Aged↗
PubMed1982

Incidence of skeletal complications in renal graft recipients. Effect of changes in pharmacotherapy.

The purpose of this study was to examine whether the occurrence of skeletal complications of renal transplantation is affected by a reduction in the steroid dose and avoidance of hypophosphataemia after the operation. A group of 36 patients that had been given smaller steroid doses and where non-phosphate-binding antacid had been given to most of the patients with hypophosphataemia were compared with a group of 144 long-term survivors given the formerly used, higher dose of steroids, and also phosphate-binding antacid agents. The modification of the regimen did not reduce the incidence of spontaneous fractures but none of the patients developed osteonecrosis after this change (P less than 0.1). Patients in the group receiving non-phosphate-binding antacids displayed a higher serum phosphorus level (P less than 0.1). Our results suggest that the development of osteonecrosis after renal transplantation may be avoided by reducing the steroid dose and avoiding hypophosphataemia.

Adolescent↗
PubMed1981

Skeletal complications following renal transplantation.

The occurrence of skeletal complications was examined in a series of 204 renal graft recipients who had maintained graft function for more than 12 months. Osteonecrosis was observed in 22 of the patient (11 per cent) from 5 to 46 months after the transplant operation. The lesions were often multifocal, with as many as 40 joints affected. The most common site was the femoral head, necrosis of which was recorded in 24 instances. The lesions here present a major clinical problem, and total hip replacement was deemed necessary in 4 cases, in all of which an excellent result was achieved. Fractures had occurred after the transplantation in 53 patients (26 per cent), against only 6 before the operation. A total of 109 fractures had been sustained after periods ranging from 1 to 58 months, the most common site being the pelvic bones. The fractures were treated according to standard principles; no complications were encountered. The skeletal complications were equally common among the males and females; they tended to occur at advanced ages. They occurred to roughly the same extent whether the graft was from a related or a cadaveric donor and whether the patient had received one or more grafts.

Adolescent↗
PubMed1981

Changes in bone histomorphometry and bone mineral during treatment of osteoporosis with 1 alpha-hydroxyvitamin D3 and calcium.

Treatment with 1 alpha-OHD3 supplemented with calcium will possibly unveil symptoms of spinal pain (8/10) and increase physical activity (7/10) in patients suffering from osteoporosis. An increase in trabecular bone (8/10) as well as a decrease in bone resorption (9/10) accompanied by measured increased bone mineral (6/10) has been observed. Some patients did not show any response to this kind of treatment.

Aged↗
PubMed1980

Bone scanning of the spine and thorax in idiopathic thoracic scoliosis.

Bone scanning of the spine and the anterior thorax was performed in 5 girls with recently diagnosed, progressive, thoracic, idiopathic scoliosis. In all patients, the scan of the spine showed a homogenous isotope uptake which was considered to suggest that, at least during the early stages of the development of the spinal deformity, there are no obvious disturbances of the metabolic activity of the affected vertebrae in idiopathic, thoracic scoliosis. On the contrary, in all patients there were differences in isotope activity between ribs on the left and right side at the costochondral area. In 4 of the patients, the higher uptake was found in the ribs on the concave side, which might indicate that the longitudinal growth of the ribs on this side was increased as compared with that of the ribs on the opposite side. Because of the restricted number of patients allowed to be included in this study, this observation could not be verified statistically and has to be considered preliminary, in need of verification as well as of further investigation.

Adolescent↗
PubMedDate not supplied

Avascular bone necrosis in the renal transplant patient: a discriminant analysis of 144 cases.

The purpose of this study was to seek ways of reducing the risk of avascular necrosis by examining certain potentially predisposing factors in the renal transplant patient. A group of 19 recipients who had avascular necrosis were compared with 125 recipients wo did not have this complication as reflected in the clinical factors, immunosuppressive therapy, and various biochemical parameters during the first year after the transplant operation. The serum phosphorus level two months postoperation was significantly lower in the group with avascular necrosis (p less than 0.01). Discriminant analysis showed that recipients who had hypophosphatemia at this time, who were older and who displayed slower normalization of the renal function were more likely to develop avascular necrosis. There were no differences in the individual steroid dose, but it is reasonable to assume that a general dose reduction would reduce the risk of avascular necrosis. A low serum phosphorus level during the interval after transplantation, when secondary hyperparathyroidism is still present, may be a predisposing factor. Attempts to avoid hypophosphatemia are recommended, either by replacing phosphate-depleting antacids by agents with a smaller phosphate binding capacity, or by supplementing the supply of phosphate.

Adult↗
PubMedDate not supplied

Spontaneous fractures in the renal graft recipient: a discriminant analysis of 144 cases.

In a search for factors predisposing to the occurrence of spontaneous fractures in the renal organ transplant patient, a comparison has been made of 38 recipients sustaining spontaneous fractures and 106 without this complication. The comparison was made with regard to the clinical findings, the immunosuppressive therapy given, and the results of the biochemical analyses, all covering the first year after the transplant operation. There were no differences in the clinical findings or the biochemical analyses between the groups. An analysis of the steroid doses showed that, during the first three months after the transplant operation, these were lower for the fracture groups than for the controls (p less than 0.01), as was the case for the oral dose of prednisone, the total dose of all steroids, and the mean daily dose of these drugs in relation to body weight or body surface area. One possible explanation of this unexpected observation is that cortisone in high doses inhibits bone resorption during the period after the transplant operation when secondary hyperparathyroidism is present.

Adolescent↗
PubMedDate not supplied

Avascular necrosis of the bone in 99 renal allograft recipients.

Avascular necrosis of bone is a serious complication associated with steroid therapy in high dose. Ninetynine patients with functioning renal allografts transplanted 1964-1973 and subjected to steroid therapy were examined with regard to this complication. Osteonecrosis developed in 8 patients afflicting 13 joints. The process was localized to the femoral head, the condyles of the femur, tibia and the head of the humerus. The symptoms became manifest 7-33 months after the first transplantation. The severity of the disorder in 3 patients did not allow rehabilitation by conservative means. The roentgenographic, scintigraphic and clinical findings are described and the orthopaedic treatment discussed.

Bone Diseases↗