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Biomedical subjects

E Morscher

Publications and source records attributed to E Morscher.

At least 37 records · Page 2Linked to original sources
PubMed1995

[Functional and morphological results of transplantation of vascularized knee joints in a dog model--a preliminary report].

Functional and morphological results of transplantation (n = 3) and replantation (n = 4) of vascularised total knee joints were compared in a canine model. Follow up time was 6 months. All vascular anastomoses remained patent and all osteotomies healed. Replanted animals displayed normal static weight bearing in contrast to the transplant recipients, which showed reduced weight bearing after 6 months compared to preoperative values. Mild to moderate signs of chronic allograft rejection were detected in all transplanted animals. Functional results were correlated with morphological outcome demonstrating the relevance of adequate control of rejection.

Animals↗
PubMed1994

Ureteroarticular fistula after total hip replacement. A case report.

A fistula between the ureter and the acetabular space developed in a woman 69 years of age after revision surgery for a total hip arthroplasty. Symptoms were intermittent macrohematuria and swelling of the leg. The diagnosis was confirmed by arthrography and an elevated creatinine level in the aspirated fluid. After nephroureterectomy, symptoms disappeared. We conclude that the differential diagnosis of persisting unusual symptoms after total hip replacement has to include a fistula between the total hip prosthesis and urinary tract, even in the absence of open sinuses.

Acetabulum↗
PubMed1994

[Natural course in spondylolysis and spondylolisthesis].

The incidence of spondylolysis is approximately 5-6% in the white population. Males and females are equally affected. In about one third of the cases spondylolysis is associated with spondylolisthesis. For the etiology mechanical and genetic factors are important. At the L4 level mechanical factors play the dominant role, while at the L5 level genetic factors are equally important (size and orientation of the facet joints, dysplasia of the vertebral arch). Increased risk for low back pain is found in the presence of the following factors: spondylolisthesis exceeding 10 mm, a low lumbar index, increased lumbar lordosis, spondylolysis at the L4 level and early beginning of symptoms. In the absence of one of these factors the risk for low back pain in adulthood is not greater than in the normal population. This statement is supported by the fact that in a low back clinic with more than 2000 patients with low back pain, the incidence of patients with spondylolysis was not higher than in the normal population. In our own study we followed up 31 patients. The majority of them were symptomatic during adolescence. After a follow-up time of 28 years on average 20 of them stated that they had no pain since adolescence, 8 had only occasional pain and only 2 had undergone operative treatment because of significant low back pain.

Adolescent↗
PubMed1994

[Elective total hip prosthesis management in patients over 80 years of age].

Ninety-five primary elective total hip prosthesis procedures were carried out in patients over 80 years of age (average 82.9 years). The results were studied retrospectively to determine the individual risk-advantage relationship and the general cost-advantage relationship taking the social aspects into consideration. Fractures and emergency procedures were excluded. Ninety-three percent of the patients had preexisting general illnesses. There were no local or general complications in the peri- and postoperative courses of 86% and 85%, respectively. The general complications included urological (6%), cardiovascular (5%) and abdominal (3%) problems. The only death (myocardial infarction) took place 4 weeks after the operation during the rehabilitation phase. The average hospital stay was 23.3 days; 20% of the patients were then able to return home, while 80% were sent to another institution for further care (geriatric department, rehabilitation), where the average stay was 36.7 days. The total inpatient treatment period was on average 52.3 days. At the time of the last follow-up, an average of 4.6 years postoperatively, 75% of the patients were alive with an average age of 87.4 years. Seventy-nine percent were still able to live alone and look after themselves; 81% were independent or only partially dependent (living in a retirement home). Ninety-three percent had no pain or only mild pain. If indicated, the operation risk factor for total hip prostheses in patients over 80 years is obviously low, and the results are good. This operation permits the patient to have many years free of pain, to remain independent, and to achieve a clearly higher quality of life. In this way one can also save on the high cost of many years of nursing care.

Activities of Daily Living↗
PubMed1993

Principles of acetabular fixation in THR with special reference to the "press-fit cup".

The "press-fit cup" has been developed by the author according to the current well known principles of cementless fixation of acetabular cups in THR. Its concept is to achieve primary stability through press-fit, by flattening the dome of the hemispheric cup and by using a cup size 1.5 mm larger than the reamer used previously. The coating (Sulmesh) consists of a net shell of four layers of orderly oriented wire meshes with specific pore size and porosity volume. The pure titanium wires are bonded together. The histologies of retrieved cups shows extensive bony ingrowth both in animal experiments and in autopsy specimens. In a radiological follow-up of 100 consecutive primary total hip replacements, the press-fit cup showed complete radiological integration in all 3 zones in 97% of cases. Nonprogressive radiolucencies were found in zones I and III in only 3% of cases.

Acetabulum↗
PubMed1992

Repair of lumbar spondylolysis with a hook-screw.

A hook-screw has been devised to link the vertebral arch and superior articular process across the defect of a spondylolysis. This method of direct repair overcomes the difficulty of fixation in dysplasia of the arch and avoids crossing the defect with a screw. Compression and a bone graft are applied to the defect to obtain union. This procedure has been used in 33 patients followed for an average period of 3.5 years, and has given satisfactory relief of back pain in 79% and radiographic fusion in 73%, with better results in patients under 20 years of age. Associated degeneration and instability of the disc spaces should be assessed before operation by magnetic resonance imaging so that a standard intervertebral fusion can be used if indicated rather than this direct approach to the lysis. The technical problems encountered and the recent addition of a compression spring to the hook-screw are described.

Adolescent↗
PubMed1992

The modified Mayo procedure combined with basal valgus osteotomy of the first metatarsal for severe hallux valgus.

The modified Mayo procedure corrects valgus deformity of the great toe secondary to osteoarthritis in the first metatarsophalangeal joint. Basal osteotomy of the first metatarsal to correct metatarsus primus varus and to maintain correction of the valgus deformity may be performed simultaneously. We retrospectively reviewed the results in 55 of 70 feet treated by this combined procedure. The average duration of follow-up was 4.2 years (range 0.5-6 years) and the average age at operation was 63 years (range 45-80 years). The results were either very good or good in 82%, moderate in 14%, and poor in 4%. Our technique of basal osteotomy of the first metatarsal is a simple and effective procedure to correct metatarsus primus varus and may restore the distal transverse arch. It should be considered as a possible method of treatment when the intermetatarsal angle is greater than 10 degrees.

Adult↗
PubMed1991

[Principles and pathogenesis of post-traumatic axial malalignment in the growth years].

Deviations of the axis or leg-length discrepancies after fractures in children and adolescents can be due to growth disturbances or can be the result of incomplete reduction of the fracture. We distinguish between four types of growth disturbances. In type I, the overall growth activity of the cartilage is increased; growth is then enhanced, which results in the affected bone being too long without deviation; this usually occurs after fractures of the metaphysis or diaphysis. In type II, activity, the epiphyseal cartilage is severely impaired or completely arrested. The direction of growth is unchanged. This results in shortening of the bone, usually due to severe damage to the germination zone of the growth cartilage after destruction of the vessels or infection. In type III, growth of the epiphyseal plate is partially stimulated. The consequence of this disturbance is deviation of the axis with overgrowth (this is in fractures of the proximal tibia). Type IV is characterized by an asymmetric arrest of growth. This results in deviation of the axis and shortening. The cause of such growth arrest can be epiphyseolysis or epiphyseal fracture. The defect in growth cartilage heals with a bone bridge. This is a very serious kind of growth disturbance, and it occurs in only 1% of all fractures before skeletal maturity. Correction after incomplete reduction of fractures during growth can be direct or indirect and specific or nonspecific. Direct corrections occur in combination with fracture healing; indirect corrections occur with physiological changes of the growing skeleton without association with the healing process.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

[Failures of knee joint prostheses. An analysis of knee prostheses and component revisions, 1980-1987].

Total knee arthroplasty has become more common in the last 20 years as a result of the continuous improvement in prosthetic design and operative techniques. Therefore, there have also been more failures. To show the reasons for these failures and the difficulties and results of revision surgery we studied the 48 uni- or tricompartmental revisions of total knee arthroplasties we performed in our institute between 1980 and 1987. Twelve to 94 months (mean 40.4) after revision we found 66% good or very good results. The main reason for failure was a poor surgical technique, which we found in 69% in unicompartmental, and in 28% in tricompartmental prostheses. Revision surgery needs a high level of practical knowledge and flexibility. The main problems consist of correction of the alignment and the filling of bone defects. Thus, we reconstructed ten large defects at the tibial plateau, which resulted in one very good, seven good and two moderate results.

Aged↗
PubMed1990

Treatment of infected joint arthroplasty.

Sixty-two patients presented with an infected total hip arthroplasty. Their management depended on their general medical condition, the clinical signs of infection, the type of infection, the degree of fixation of the components and the available bone stock. Treatment consisted of one of the following: debridement and lavage without removing the prosthesis, one or two stage revision arthroplasty, or excision arthroplasty. There were 11 early and 51 late infections. The commonest bacterium isolated was Staphylococcus epidermidis (30%). Primary revision of the femoral component was slightly more successful with a cemented prosthesis than with an uncemented prosthesis. The overall success rates for cemented and uncemented femoral components were roughly comparable (91.5%:90%). We make various recommendations for the management of infected total hip arthroplasties based on our experience.

Adult↗
PubMed1990

Comparison between straight- and curved-stem Müller femoral prostheses. 5- to 10-year results of 545 total hip replacements.

Between 1977 and 1982, 545 cemented femoral prostheses were implanted, in combination with a noncoated cementless polyethylene acetabular component (RM cup). Three hundred and eighty-one straight-stem and 76 curved-stem Müller femoral components were implanted, as well as 88 collared components with a 130-mm stem and a 130 degrees neck-shaft angle, derived from a long-stem steel prosthesis. Survivorship analysis of revisions for aseptic loosening at 10 years revealed 97% straight-stem survival, 91.6% curved-stem survival, and 88.3% 130 degrees stem survival. "Survival" curves were also constructed for radiological loosening, and the survival rates (patients without radiological evidence of loosening) were 69.8%, 78.8%, and 63.1% respectively at 10 years. The 130 degrees collared stem was associated with significantly less acetabular loosening than the other prostheses. This resulted in less calcar resorption, but there was a higher rate of stem loosening. Acetabular loosening and associated wear products appear to be responsible for calcar resorption, and stress shielding of the calcar appears to be of minor importance in the pathogenesis of aseptic stem loosening. Better cementing techniques have improved survivorship of the curved-stem prosthesis, and early fears of high rates of radiological loosening with the straight stem have not been substantiated.

Adult↗
PubMed1990

The relationship between periosteal division and compression or distraction of the growth plate. An experimental study in the rabbit.

We subjected the proximal tibial growth plates of six-week-old rabbits to either compression or distraction of 1 kg on both legs. On one side the proximal tibial periosteum was divided circumferentially and stripped for 1 cm. After six weeks, growth was measured at both proximal and distal growth plates. Compression inhibited total tibial growth and distraction enhanced it. The compressed growth plate grew less and the distracted growth plate grew more, but there was a reciprocal change at the other end of the bone. Periosteal division enhanced growth at the adjacent growth plate but inhibited it distally; the effect of distraction was enhanced and that of compression reduced. We found reciprocal growth rates at the proximal and distal growth plates. Relatively small amounts of compression or distraction did affect total bone growth. Periosteal division appeared to induce overgrowth at least partly by a mechanical effect; it may be useful as an adjunct to other methods of leg lengthening, though not to epiphyseolysis.

Animals↗
PubMed1990

Cementless uncoated polyethylene acetabular components in total hip replacement. Review of five- to 10-year results.

We reviewed the results of 545 consecutive total hip replacements using a cementless non-coated high-density polyethylene acetabular component combined with a cemented Müller stem at five to 10 years. In all, 421 patients (445 hips) were available for review, 118 by questionnaire and 303 by examination and radiography. Of these, 86% had a good or excellent result. We found a high rate of radiological loosening of the cup after the sixth year, and a high rate of clinical loosening after the eighth year. Loosening was commoner in women, in younger patients and where a smaller size of acetabulum had been used. Calcar resorption was significantly related to loosening of the acetabulum. Loosening appeared to be mainly due to polyethylene debris produced by micro-movement of the acetabulum against the bone, which had resulted in a giant cell foreign body reaction and subsequent bone erosion. We have abandoned the use of this prosthesis and suggest that direct contact between bone and polyethylene should be prevented by a coating of metal or some other material.

Acetabulum↗
PubMed1990

[Total prosthesis arthroplasty in femur head necrosis].

In young patients with advanced necrosis of the femoral head, the short- and medium-term results of total prosthesis arthroplasty are the most satisfactory. However, the prospect of aseptic loosening hangs over such arthroplasties like Damocles' sword. Reports from the literature suggest that, in addition to the age of the patient, there is also an endogenous factor that can be responsible not only for the etiology and pathogenesis of the necrosis, but also for the early loosening of the prosthesis. We have followed up 54 patients (73 hip joints) who had total hip replacement as a result of necrosis of the femoral head between 1976 and 1988. Altogether, 3 acetabular and 5 femoral shafts had to be replaced (7 patients). This corresponds to a loosening rate of 10% after an average of 4.9 years. Hence, the prosthesis changing rate is lower than that reported by other authors, but is still higher than in patients with coxarthrosis. Only 2 of 52 cemented shaft prostheses had to be replaced; the average age of these patients was 61.4 years. Of the 21 cement-free shaft implantations, 3 had to be replaced, the average age of these patients being 42.9 years. The fact that the average age of the latter patients was lower may be the reason for the revision rate not being significantly higher for the non-cemented shafts. In view of the fact that necrosis of the femoral head can rapidly result in the patient becoming an invalid if it is allowed to follow its natural course, hip joint prostheses should also be offered to younger patients.

Adult↗