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E Morscher

Publications and source records attributed to E Morscher.

At least 19 recordsLinked to original sources
PubMed2003

[Criteria for evaluating hip joint arthroplasty].

Development and state of the art of the Total Hip Replacement (THR) are reviewed. Progress since the introduction of the "low friction arthroplasty" by John Charnley/UK over 40 years ago consists first of all in an impressive reduction of the number and severity of complications: infection, failures of materials, thromboembolism and aseptic loosening. Current 10 year survival rates should not be lower than 97%. This high standard of THR performance has become the greatest obstacle to further progress. The most important factors for the assessment and the outcome of a THR are the operative (cementing) technique, the mechanical design of the prosthesis, the characteristics of the surfaces (implant, bone cement, bone) and the materials used. A prognosis of the survival of a THR can be made based on negative subjective clinical and negative objective criteria. On X-ray films these criteria are shown first of all as changes (radiolucency, osteolysis, progressive migration) at the implant-bone interface and within the periprosthetic bone itself.

Arthroplasty, Replacement, Hip↗
PubMed2001

[Acetabulum revision. Classifications and treatment possibilities].

Several different defect classifications have been published. The most commonly used are described. For clinical practice, differentiation between "contained" and "noncontained" or segmental defects has proven useful. If the acetabular rim provides support, press-fit cups can be used without screws. With an appropriate reaming technique, it is possible to create a sufficiently supportive bed for the implant in many cases. This allows the use of a press-fit acetabular component over a wide range of defects as long as a tilting of the cup can be avoided. Between 1988 and 1995, 439 acetabular cups were revised at the Orthopedic University Clinic in Basel, 171 of them using the Morscher press-fit cup. After a mean follow-up of 7.1 years, not a single cup had to be revised for aseptic loosening. The 9.5% dislocations were due to abductor insufficiencies because of trochanteric pathologies or muscular alterations from former approaches.

Acetabulum↗
PubMed2000

Total hip arthroplasty after arthrodesis of the hip joint.

The results of 15 conversions of a hip arthrodesis into a total hip arthroplasty performed in the years 1980-1995 are reported. Fifteen patients (8 men, 7 women) underwent total hip arthroplasty 30.9 (range 2-61) years after spontaneous or operative fusion of a hip joint. The primary indications of the conversion were low-back pain (n = 10), knee pain (n = 2) and hip problems (n = 3). At follow-up examination 5.4 (range 2-13.3) years postoperatively, the Harris Hip Score averaged 86.0 (range 70.1-99.0). Six patients were pain-free, 7 had less pain, 2 felt no improvement of pain. All patients confirmed that they would undergo the operation again. The Trendelenburg sign was negative or mild in 8 patients and moderate to severe in 7. Aseptic loosening of 2 stems (1 cemented, 1 cementless) and 2 deep infections required revision surgery. We conclude that this operation can lead to satisfactory results even after a long duration of the arthrodesis. However, full function with no pain and a negative Trendelenburg sign could be obtained in only 20% (3/15) of the cases.

Adult↗
PubMed2000

Alpine and cross-country skiing after total hip replacement: 2 cohorts of 50 patients each, one active, the other inactive in skiing, followed for 5-10 years.

2 groups of 50 patients each, matched for age, weight, height, gender and type of implant, were clinically and radiographically examined after THR. Group A regularly carried out alpine skiing and/or cross-country skiing, while group B did no winter sports. At 5 years, no signs of loosening were found in group A, whereas 5/60 implants in group B had signs of loosening, mostly of the femoral component (p < 0.05). At 10 years, 30 patients remained in group A and 27 in group B. No new cases of loosening were found in group B, but 2/30 cases in group A. There was a higher (p < 0.05) average wear rate in group A (2.1 mm) than in group B (1.5 mm). The wear rate was particularly high (3-4 mm) in physically very active patients in group A with localized osteolysis at the interface. It seems likely that in an even longer follow-up, the number of cases of aseptic loosening would be greater in group A than group B. Our findings, combined with the results of previously-published biomechanical studies, do not provide any evidence that controlled alpine and/ or cross-country skiing has a negative effect on the acetabular or femoral component of hip replacements. The results of the biomechanical studies indicate, however, that it is advantageous to avoid short-radius turns on steep slopes or moguls.

Aged↗
PubMed2000

Morton's intermetatarsal neuroma: morphology and histological substrate.

Twenty-three biopsies from patients with the typical symptoms of intermetatarsal neuroma (so-called Morton's metatarsalgia) were compared histologically and semi-quantitatively with 25 plantar nerves from the intermetatarsal space III/IV gained at autopsies from cases where no problems in the forefoot had been recorded. The histomorphological examination of the nerves from autopsies revealed the same findings as were found in the biopsies. Thus, qualitatively, the nerves from patients could not be distinguished from those gained at autopsy. The only difference was the diameter of the resected nerves: semi-quantitative analysis of the nerves showed that the 17 thinnest ones were all from autopsies and the five thickest ones from biopsies of symptomatic patients. At medium diameters, however, there was wide overlap of the two groups. The study yielded a specificity of the swelling of 80 % and a sensitivity of 78%. From these results it must be concluded that diagnostic MRIs or ultrasonography, are unnecessary for decision-making about operative treatment and are not superior to exploratory local anaesthesia. Since histomorphological findings in intermetatarsal neuroma (so far accepted as the gold standard for confirmation of that diagnosis) were the same as findings in autopsied (normal) specimens, the value of postoperative histological examination is questioned. It merely proved that the nerve has been resected.

Adult↗
PubMed1997

Three-to 7-year results with the uncemented SL femoral revision prosthesis.

Between 1988 and 1991, 40 Wagner SL femoral revision stems were implanted at the Orthopaedic Departments of the University of Basel and of the Kantonsspital Liestal, Switzerland. The indications were: 27 cases of extensive bone resorption and destruction of the proximal prosthetic bed, seven periprosthetic fractures, two Girdle-stone situations after removal of infected total hip arthroplasty (THA), 1 case each of primary arthroplasty for congenital dysplasia of the hip, failed osteosynthesis of a pertrochanteric fracture, subtrochanteric femoral fracture and femoral fracture with subsequent osteomyelitis. The average follow-up time was 47 months. The average age of the patients was 70 years (range 37-85 years). The average preoperative hip score was 32 points, postoperative 78 points. We noted to severe complications such as thrombosis, pulmonary embolism or nerve injury. No case of early infection has occurred to date. Four hips required further revision, one after a haematogenous infection of the prosthesis 2 years after implantation, one 4 weeks after surgery because of a stem which was significantly undersized compared with the medullary canal of the femur. Two hips were revised after 3 and 4 years, respectively, for continuous subsidence and loosening in the medullary canal. Both revisions were successfully achieved using a femoral component of larger diameter. We recommend the Wagner SL femoral revision stem, not as a routine procedure to treat loosening, but for patients with severe femoral bone resorption after THA or periprosthetic fractures, those in the Girdlestone situation and geriatric patients with pertrochanteric or subtrochanteric fractures.

Adult↗
PubMed1997

Rationale of a flexible press fit cup in total hip replacement. 5-year followup in 280 procedures.

A consecutive series of 280 total hip replacements in 261 patients using the Press Fit Cup with a minimum followup of 5 years is presented. The Press Fit Cup is a nonmodular acetabular component with a porous coating made of titanium fibers. It has one peg and is 1.5 mm oversized with biradial eccentricity. It has a flattened pole area, requires no screw fixation, and partially preserves elasticity. The mean age was 71 years for women, 70 years for men. Forty-seven patients (49 hips) died before the 5-year review, and five patients were unable to return for the followup because of physical infirmity. Two hundred eighteen patients (226 hips) were available for the clinical 5-year followup, and 208 patients (213 hips) were available for the radiographic followup. No intraoperative fracture of the acetabulum occurred; four hips dislocated; 94% clinically were rated as excellent or good. One hip in a patient with rheumatoid arthritis had to be revised for aseptic loosening of the cup and nine femoral stems had to be revised. No migration of the cup could be measured. There was no osteolysis seen around the cup. In six cases a radiolucent line was seen in Zone 1, and in eight hips in Zone 3. There was one hip with a continuous radiolucent line which was considered radiographically loose.

Adult↗
PubMed1996

[Spinal pseudarthroses].

Pseudarthroses of the spine are classified into congenital, acquired non-traumatic, posttraumatic and postoperative (iatrogenic) pseudarthroses. The various types of non-unions of the spine are described according to their clinical and radiological appearance. In line with their clinical importance, special attention with respect to the operative treatment is given to non-union of the axis of C2 and to spondylolysis. For the pseudarthrosis of the dens a posterior fusion according to Gallie-Brooks is recommended, in spondylolysis without marked slipping a "direct repair" should be considered in young patients.

Child↗
PubMed1996

[Open laser surgery on the locomotor apparatus].

The first applications of laser in surgery of the locomotor apparatus in the early 1980s used the haemostatic properties of laser to diminish the amount of substitution of coagulation factors in haemophiliac patients. Only since the early 1990s has a device been available in corporating the pulsed holmium:YAG laser which works in a fluid medium without relevant side effects. Apart from haemostasis, the cutting function and tissue ablation, together with the thermal shrinking effect, are exploited in arthroscopy and percutaneous disc decompression. Now that the biophysical mechanisms of action have been elucidated, nothing stands in the way of the use of infrared lasers in open surgery of the locomotor apparatus in some indications. In a prospective clinical study we included 30 consecutive patients who underwent open laser surgery from November 1992 to August 1994, for the following indications: the sparing haemostatic tissue ablation was used for synovectomy or for bony resection in osteophytes and osteochondromas of different locations, an osteoid osteoma and a painful sacral hyperplasia in the presence of incomplete sacral meningomyelocele. With bleeding eliminated, the shaping was much easier. The non-ablative shrinking produced less tissue loss and a stabilizing strengthening of tissue at the margins of soft tissue resections, e.g. in jumper's knee, tennis elbow and Achilles tendon cysts. All laser functions that are useful in open surgery have also been used in sequestered disc herniations that are inaccessible a percutaneous procedure and, in spinal decompression, for remodelling of the posterior spine contour. An analgesic effect of laser limited the postoperative administration of analgesic drugs to an average of 3 days. No complications related to the laser treatment were observed. At follow-up 12-21 months after operation, 25 of the 30 patients in this heterogeneous population showed complete or near-total healing of the operated pathological finding, and a further 3 patients showed significant improvement. To what extent these very encouraging results will persist will be shown by long-term observation.

Bone Diseases↗
PubMed1996

Bone growth and remodelling after fracture.

We used a rabbit model to investigate the mechanism by which the angulation of fractures is corrected in children. We produced a transverse proximal tibial fracture in one leg of 12 eight-week-old New Zealand white rabbits and measured bone alignment and length and the patterns of bone growth and remodelling. The angle between the joint surfaces changed rapidly to correct the alignment of the limb as a result of asymmetrical growth of epiphyseal plates. In an adult with closed plates, the angle between the joint surfaces cannot therefore improve. The angle at the fracture itself showed slow improvement because of bone drift and the asymmetrical growth of the epiphyseal plates. Remodelling corrected the shape of the bone in the region of the fracture. Periosteal division on the convex side increased the growth of the epiphyseal plate on that side, thus slowing the correction. The effect was relatively small, providing an indication that factors other than the periosteum are important in inducing correction. External torsional deformities developed because of helical growth at the plate. This was probably caused by abnormal posture which induced a torque at the growth plate. Helical growth is the mechanism by which rotational deformities can occur and correct.

Age Factors↗
PubMed1995

Prevention of heterotopic ossification in hip arthroplasties by means of an early single-dose radiotherapy (6 Gy).

Radiotherapy has proven to be efficient in the prevention of heterotopic bone formation. Its importance is increasing in the treatment of uncemented implants in prosthetic hip surgery, where a localized irradiation field is applied to cover the bone-implant interface. In a prospective study the efficiency of two radiation concepts using two different doses to prevent heterotopic ossifications after total hip arthroplasties or revision arthroplasties was compared. In 7 patients after fractioned irradiation (5 x 2 Gy), two recurrences of periarticular ossification occurred, whilst in 17 patients after a single-shot irradiation of 6 Gy on the first postoperative day, no recurrences were seen. There were no side-effects from the radiation. Radiological signs of lucent cement-free implants or delayed wound-healing were absent. Thus, a single shot of 6 Gy applied within 24 h postoperatively reliably prevents heterotopic bone formation. It is safer than 5 x 2 Gy and facilitates the management of the patient.

Aged↗
PubMed1995

Outcome analysis of total knee-replacements in patients with rheumatoid arthritis versus osteoarthritis.

A total of 524 knees underwent a primary PCA knee arthroplasty between 1982 and 1989. Of these 415 suffered from osteoarthritis (OA) and 61 from rheumatoid arthritis (RA). They were analyzed for differences regarding the outcome. Neither survivorship analysis nor number or type of revisions revealed statistical differences among these two groups. The knee score rose in the OA group from a median of 28 to 89 points after 1 year and then dropped to 87 points between 54 and 118 months. In the RA group the median of the knee score rose from a preoperative value of 21 points to 90 points after 1 year but then dropped to 77 points at the most recent follow-up. This development was probably the result of general progression of the disease. Even in the RA group the rating was still "good" at the latest follow-up. Regarding the benefit of such a procedure in a polyarticular disease and its preservation over a long period of time, total knee arthroplasty can be recommended for patients with RA, and preferably the cemented version.

Adult↗
PubMed1995

[Treatment of infected total prosthesis arthroplasty of the hip joint].

With a median follow-up of 8 (1-13) years in our series, we are familiar with the entire courses in 62 infected hip arthroplasties, treatment starting between 1980 and 1986. The primary treatment was débridement with suction/irrigation in 6 cases, one-stage replacement of the prosthesis in 32 occasions and two-stage replacement in 23 cases. Only one definitive Girdlestone procedure was done. With further operations successful healing was finally achieved in all 62 hips. In 74% healing was primary, this being the case in 91% (10/11) of early and 71% (36/51) of late infections. Device-retaining procedures can be tried, particularly in early infections with low-virulence bacteria and a stable implant. One-stage revisions can be done in early and late low-virulence infections with loosening of components if bone and soft tissue are in good condition. In all other situations a two-stage procedure is recommended. As a rule, reimplantation can be done within 2 weeks. In cases with recurrent infection, replacement should be delayed for several months. As an alternative, several open débridements with reimplantation of a new prosthesis after 2 weeks can be considered. Girdlestone resection arthroplasty should be avoided whenever possible. Antimicrobial treatment is of great importance: it should be maintained for at least 3 months and in any case until 1 month after normalization of laboratory and clinical signs of infection.

Adult↗
PubMed1995

[Lesions of the growth plate caused by sports stress].

Besides the positive physiological, psychological and social aspects, sports activities in adolescents bear the risk of injuries and overuse of the locomotor system. Previous examinations have shown that increased stress to the growth plates by sports activities, in relation to the intensity of strain during growth spurts, can influence normal growth. In female gymnasts, hormonal changes can decrease the growth speed and long-term growth. On the other hand, during more intensive phases of growth the column cartilage of the growth plate is the weakest part of the locomotor system because of the influence of somatotropin and low levels of testosterone. This can cause subchondral stress fractures in the growing cartilage that later on, if missed or not sufficiently treated, can cause osteochondrosis dissecans. The apophysis of tendons of big muscle groups can show loosening of the apophysis caused by increased muscle strength and acute or chronic microtrauma. Male adolescents show an incidence of lesions in the relation of 9:1 to female adolescents. The therapy for apophyseal lesions is generally nonoperative. Due to the persistent growth possibility, pseudotumors can occur, which can cause problems in differential diagnosis among skeletal tumors. Too high pressure, pushing and tearing forces can influence growth. Later examinations of previous high-level sportsmen and patients with coxarthrosis with and without a sports history show that blockage of the rotation of the foot during growth, for example caused by soccer shoes, can cause high pushing forces on the femoral epiphysis, which can lead to epiphyseolysis cap. fem. lenta and thereby to pre-arthritic deformities. This is overcorrection of the "physiological" epiphyseolysis, described by Morscher. Knowledge of the reduced strength of the growth plate indicates better adaptation of training and supervision of the adolescent high-level sportsman. A regular check-up of the growing athlete and a reduction in sports intensity during the growth spurts, prohibition of negative training parts and sometimes even prohibition of sports at all, if there is a lesion of the growth plate or hormonal disorders, are sometimes necessary to minimize late defects. In addition to this, a reduction of strain in some sports and, for example, prohibition of rotation-blocking soccer shoes in the adolescent soccer player is necessary.

Adaptation, Physiological↗
PubMed1995

[Tendon diseases].

Explore the source record for details and available documents.

Collagen Diseases↗
PubMed1995

[Tendon cysts].

We report two cases of intratendinous cysts of the Achilles tendon, which occurred after treatment of tendon ruptures. Intratendinous cysts develop in the Achilles tendon and patellar ligament. The clinical diagnosis should be confirmed by sonography or magnetic resonance imaging. Surgical excision of the necrosis is the therapy of choice.

Achilles Tendon↗
PubMed1995

[The value of long-term results for quality control].

Quality control is as important today as always. In orthopaedic surgery this largely means follow-up of patients. Long-term thinking and planning need long-term outcome studies, since orthopaedic therapy, especially an operation, has lifelong consequences. It is essential to know whether these are better or worse than the natural course of the disease. An operation is not always the best solution. Long-term and short-term continuous control are equally important; both have to be done despite of great practical difficulties. The assessment must become more patient-related than technique-related. Prospective studies cannot provide quick long-term answers; retrospective studies are needed, too. Political aspects complicate the issue. They are also addressed in this paper.

Humans↗