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Biomedical subjects

E Morscher

Publications and source records attributed to E Morscher.

At least 55 records · Page 3Linked to original sources
PubMed1989

[Perioperative risks and problems in total hip joint replacement].

In a population of 689 patients with primary total hip arthroplasties, perioperative problems and complications were investigated. A preoperative cardiovascular disease was found in 32%, obesity in 18% of the patients. The death-rate was 0.43% in a population of patients, two thirds of whom was older than 60 years, one third even older than 70 years. The importance in preoperative evaluation of health and in treatment of various diseases is emphasized. Postoperative management is crucial to reduce thromboembolisms, urinary retention and infections.

Aged↗
PubMed1989

Cementless press-fit cup. Principles, experimental data, and three-year follow-up study.

The concept of the press-fit cup includes an operative defect as small as possible, achievement of intrinsic stability by press-fit, and surface coating by an orderly, oriented wire mesh coating. The design is a modified hemisphere with flattening in the pole area and oversized cup diameter. A first series of press-fit cups were fitted with titanium nitride-coated stainless steel mesh. The manufacturing of such chemically pure titanium has only recently become feasible. Animal experiments using mountain sheep have shown an increase in the stability of the press-fit cup within the acetabulum with time and progressive bony ingrowth; this was verified in cups retrieved at autopsy. Three hundred eighty-seven first-generation titanium nitride-coated stainless steel mesh implants have been reviewed with a follow-up time of 12 to 39 months (average, 16.6 months). There were no intraoperative complications related to the cup. The roentgenographic follow-up study of 330 (85.1%) hips showed only a single case with a radiolucent line in all zones (1-3) as a roentgenographic sign of loosening, i.e., fibrous ingrowth. Two cups had to be revised due to insufficient primary stability and tilting.

Acetabulum↗
PubMed1989

[Treatment of infected hip joint arthroplasty. Results of treatment of 62 infected total prosthesis arthroplasties].

The treatment of 62 cases of infected total joint arthroplasty of the hip is reported. The treatment regimen for each patient was dependent on the general medical condition of the patient and the clinical signs of infection, as well as the type of bacteria, the bony anchorage of the prosthesis and the bone stock of femur and acetabulum. Surgical treatment was one of the following: treatment of the infection leaving the prosthesis in situ; one-stage or two-stage revision arthroplasty; or excision arthroplasty (Girdlestone procedure). There were 11 early and 51 late infections. The commonest bacterium isolated was Staphylococcus epidermidis (30%). The primary success rate of revision of the shaft was somewhat better with cemented than with uncemented prostheses. The overall success rates for cemented and for uncemented shafts were similar (91.5% versus 90%).

Adult↗
PubMed1989

[Salter's innominate osteotomy. 20 years later...].

This is a retrospective review of nineteen innominate osteotomies with an average follow-up of 20, 6 years. These osteotomies were done mainly for treatment of late diagnosed congenital hip dislocation, or occasionally for persistent subluxation after orthopaedic treatment. The mean age at diagnosis was 2 years 2 months, at operation 3 years 5 months. We performed eight combined open reduction and pelvic osteotomies, eight associated pelvic and femoral varisation derotation osteotomies and only 3 isolated pelvic osteotomies. At follow-up the Charnley hip's score is 5.7 for pain; 5.4 for gait and performance, 5.6 for mobility. We found 15 hips without any significant pain and only 4 hips with mechanical pain. The Xray evaluation shows an average CE angle at 28.5 degrees, AC angle at 16 degrees and anterior coverage on "faux profil de Lequesne" at 40 degrees; 4 hips show arthritic changes, 4 others had important deformation of the head of the femur, but without diminution of the height of articular space. 6 hips (1/3) in 4 patients must be reoperated in adolescence because insufficiency of coverage of the head of the femur: 3 because technical errors and 3 because osteonecrosis with progressive cervicocephalic valgus. This historical serie with a very important follow-up, demonstrate that between 1/3 and 1/2 of cases have some kind of problems mainly radiological. The quality of results depends on the respect of the conditions and technique described by Salter, early diagnosis and absence of osteonecrosis eventually caused by prealable orthopaedic treatment.

Activities of Daily Living↗
PubMed1989

Endoprosthetic surgery in 1988.

Aseptic loosening remains the main problem of arthroplasty. On one hand, this has led to the development of new cements and improvement in cementing techniques. On the other hand, especially intensive efforts have been made in recent years to anchor the implants directly to bone. The major alternatives available today for endoprosthetic fixation are cement "pressurization" and "bony ingrowth". The differences in implant fixation, with or without cement, must take into consideration the design, surface characteristics, and the material properties of the implants as well as the operative technique. In principle, there are major differences both with regard to the biology and to the mechanics between the acetabulum and the femur. On the acetabular side, the objective of reliable fixation has been achieved at least in the medium term. Gratifying advances are also being increasingly shown in the femur. However, until today hardly any prosthetic femoral model is able to provide reliable primary results with regard to freedom from pain, as is the case with the modern cement techniques. For many orthopaedic surgeons, a "hybrid" is the solution to the problem for patients over 60 years old: i.e. cementless anchoring of the acetabulum socket and cementing of the prosthetic shaft. For young, active patients and for revision arthroplasties, with major loss of bone substance, we require a cementless technique. With this technique and use of bone transplantation, it is today possible to reconstruct even severely damaged joints and to create situations corresponding to those of a primary arthroplasty. In the knee joint aseptic loosening of cemented endoprostheses is less of a problem and the decision in favour of cementless fixation depends even more on the quality of the bone than on the hip joint. For the future it is becoming increasingly apparent that a single method on its own will not exist, but that the surgeon must choose the most suitable method (with or without cement) dependent on the case. Accurate preoperative planning becomes indispensable.

Arthroplasty↗
PubMed1989

[Therapeutic concepts in infected hip prosthesis].

In the period from January 1980 to December 1987, 62 patients with infected hip joint arthroplasties were treated. The duration of observation was on average 37 months (minimum 12 months, maximum 91 months). The choice of treatment modality depended on the type of infection, the state of anchorage of the endoprosthesis, the general condition of the patient, the type of bacterium and the state of the tissue surrounding the implant. 42 arthroplasties (67%) healed primarily. The remaining 20 were subject to 46 further operations (2.3 relapse operations/patient). 14 subsequently healed (23%) and six cases remained definitively infected.

Debridement↗
PubMed1989

[Revision arthroplasty of the hip joint with autologous and homologous cancellous bone].

On revision arthroplasty a substantial loss of bone stock is frequently encountered. To anchor the new prosthesis many different additional technical appliances, e.g. supporting rings, wire meshes and fixation screws, are suggested. However, filling of all the bone cavities by cement will lead to further peripheral defects of bone stock, worsening the situation if renewed loosening occurs. Such loosening must be expected since additional bone is damaged by the implants and the large amount of cement. Therefore, it is increasingly recognized that biologic reconstruction of the deficient acetabulum and femoral shaft by bone grafting should be the goal in revision arthroplasty, in order to restore the bone-implant interface to the site of a primary arthroplasty. Autologous bone graft is harvested from the outer iliac wing as a bone paste most easily by use of an acetabular reamer. As an additional approach is needed and the amount is not always sufficient, often homologous bone is used in solid cortico-cancellous blocks or as a bone paste ground by a bone mill. The bone banking procedure is described. At the acetabulum the grafting technique depends on whether there is a contained or non-contained defect. The cup has to be brought to the anatomical position and should be supported at several sites by the original iliac bone and not only by the graft. At the shaft, osteotomy of the greater trochanter can be avoided by a lateral transgluteal approach in the vast majority of cases (90 out of 95 cases). If still possible, a short stem is preferred to an extra-long one. Follow-up examination of 164 patients at 46 months (min. 24, max. 78 months) after cup revision showed that 8 re-revisions had been performed in the meantime: in 6 cases renewed loosening or infection had been treated by implantation of a new component; in 2 cases a Girdlestone procedure was the final outcome.

Acetabulum↗
PubMed1988

A contribution to the anatomic basis of the transoral approach to the atlas and axis.

The transoral approach (Fang and Ong 1962) allows direct free exposure of the atlas and axis. However, a morphologic description of certain structures at risk corresponding to the views at operation has so far been lacking. The present study is intended to fill this gap by giving the surgeon a transoral view of the peripharyngeal structures. This is a further instance of how classical gross anatomy needs to be continuously rediscovered in the light of clinical activities.

Axis, Cervical Vertebra↗
PubMed1988

[Long-term results of the Salter pelvic osteotomy].

We report the long-term results obtained with Salter's innominate osteotomy over an average follow-up time of 24 years. In 8 of 9 hips the innominate osteotomy was combined with an intertrochanteric femoral osteotomy. On average the acetabular angle was improved by 12 degrees. By 11 years post-operatively the acetabular angle had stabilized at a mean of 16 degrees, subsequently remaining the same through the follow-up period. The centre angle was improved by approximately 20 degrees. By 8 years post-operatively it was in the normal range around 27 degrees, remaining unchanged until the most recent follow-up examination. Among the 9 patients who were followed up there was only one mild deformity of the femoral head. We recommend Salter's innominate osteotomy for the treatment of dysplastic acetabulae with an acetabular angle of not much more than 40 degrees, for patients 2-4 years of age, and occasionally up to the age of 6.

Adolescent↗
PubMed1988

[Osteotomy to lengthen the femur neck with distal adjustment of the trochanter major in coxa vara after hip dislocation].

Hip dysplasia and treated dislocations of the hip can lead to deformity of the proximal femur with shortening of the femoral neck and proximal displacement of the greater trochanter. Shortening the femoral neck causes a reduction in the leg length and insufficient performance of the abductors in the hip. Furthermore, the mechanical axis of the knee joint is lateralized. We used a technique involving lengthening the femoral neck and distal transfer of the greater trochanter to restore the normal anatomy and normal biomechanics of the hip joint. We used three osteotomies: one at the greater trochanter, one at the proximal, and the third an oblique osteotomy at the level of the distal femoral neck. In our group of 15 patients with 16 operated hip joints, the results were satisfactory in 14 of the 16 hips. This technique is recommended in young patients with little or no degenerative changes.

Adolescent↗
PubMed1988

Development and first experience with an uncemented press-fit cup.

A new cup with a new concept of cementless fixation and new coating was designed to obtain primary stability by a press-fit mechanism. The press-fit mechanism is achieved by flattening the dome of the hemispheric cup and by using a cup size with an outer diameter 1.5 mm larger than the reamer used last. 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 advantages of the press-fit cup are the excellent adaptation with minimal resection and the preservation of the subchondral bone. The preparation of the acetabulum is easy (reaming only), no additional fixation by screws is necessary, and only a few instruments are needed. The results of 81 total hip arthoplasties using the press-fit cup and having an observation period ranging from 12 to 24 months show no clinical or roentgenographic loosening. No intraoperative or postoperative complications because of the press-fit cup were seen.

Acetabulum↗
PubMed1987

Para-articular ossification in total hip replacement: an indication for irradiation therapy.

The results of postoperative irradiation therapy after total hip replacement or resection of para-articular ossification in 25 patients are reported. The patients were kept under radiological observation for an average period of 26 months and clinical observation for an average period of 31 months after surgery. There were only two clinically relevant recurrences of para-articular ossification. The earlier radiotherapy with a total dose of 2000 rads (2000 cGy) was begun, the better was the effect. In this small population sample statistical significance could not be calculated. No side effects were detected.

Adult↗
PubMed1987

[Experiences, requirements and development of cement-free hip endoprostheses].

The main problem with endoprostheses, particularly the cementless type, is the transmission of stress from the implant to the bones and vice versa. Cement is a very good solution--at least on a short-term basis. However, the major aim in using cementless endoprostheses is to improve the long-term results as compared with those obtained when using cement. To date, this has not been possible either with more modern cementing techniques (pressurization) or with cementless endoprostheses based on the principle of bony ingrowth. The differences between cementless endoprostheses and those using cement are: the design, the nature of the implant surface, and the operative technique. Experience has shown that histologically, radiologically, and clinically (although not long-term), the results with cement-fixed acetabula are better than those with cementless prostheses. Cement-free shaft endoprostheses, on the other hand, have not yet achieved the consistently good results obtained in the femur shaft by means of pressurization. Under normal circumstances, use of a cementless acetabulum and a cement-fixed shaft is the procedure of choice. In patients under 60 years of age who are still active, as well as in repeat-arthroplasties involving substantial loss of bone, the completely cementless endoprosthesis is indicated.

Biomechanical Phenomena↗
PubMed1987

[Replacement of the head of the humerus as a rescue operation following dislocated compound fractures of the shoulder joint].

Results after conservative or surgical treatment of comminuted fractures of the head of the humerus are often unsatisfactory and complicated by pain and a severely decreased range of motion. In these patients good results have been obtained by replacement of the humeral head with the Isoelastic Humeral Head Prosthesis. Fourteen cases are reported and their results discussed.

Adult↗
PubMed1987

[Thoracic trauma with injuries of the thoracic spine].

From a major series of surgically treated patients with fractures and fracture dislocations of the thoracic spine 4 cases are presented exhibiting different trauma mechanisms and presenting with a variety of associated acute and chronic intrathoracic lesions. Surgical stabilisation and treatment of additional intrathoracic injury (vascular, lymphatic duct, empyema, posttraumatic fibrothorax) necessitated a transpleural approach, effective for the spine as well. Diagnostic radiology was restricted to minimal requirements due to urgency and/or difficulties of exposure.

Adult↗
PubMed1986

[Evaluation of scintigraphic procedures for clarifying pain conditions in hip joint prostheses].

59 patients with implanted one- or two-sided hip prostheses (n = 74) have been investigated by two different scanning techniques to detect both possible loosening of the prostheses and a possible infection as the cause of the loosening. Of the investigated prostheses 47 were loose; in 45 cases this was evidenced by the bone scan using Tc-99m-DPD, thus showing a sensitivity of 95%. Specificity was 89%. In 21 cases (45%) of loose prostheses an infection could be clinically proven. With the aid of In-111 labeled leukocyte scans, 17 of 21 cases were correctly diagnosed as infected, showing a sensitivity of 91%, while the specificity was 94%. In view of the 93% accuracy, bone scanning can be regarded as the method of choice in detecting loosening of prostheses. The 91% accuracy in proving or ruling out infection by means of the leukocyte scan is high enough to assert correct findings in most cases. The main disadvantage of this method is the very demanding technique for marking of white blood cells.

Diphosphonates↗