In this study, we tested the stability of the xenograft SURGIBONE and of human iliac crest graft depending on the donor's bone density. The mean load bearing capacity of SURGIBONE was 4816 N, the compressive strength 32.8 N/mm2. This even exceeds the values given by the producer. Yet in clinical use the material caused problems by collapses or lysis of the graft. According to our results, those failures can not be explained by missing primary stability. Perhaps there is a immunogenic reaction of the host against the remaining protein as it once was proved for the "kielspan"-graft. The iliac crest grafts of donors with normal bone density had a load bearing capacity of 3397 N. Grafts of donors with reduced bone density of less than 60 mg/ml Ca-Equivalent showed reduced load bearing capacities of 2265 N. DEXA (Dual-Energy X-Ray Absorptiometry) seems to be suitable to scan preoperatively the iliac crest graft stability in order to recognize the danger of reduced stability by osteoporosis.

Absorptiometry, Photon↗

PubMedDate not supplied

[Hip surgery in early childhood].

Congenital dysplasia of the hip after conservative treatment does not always lead to satisfactory results. Remanent hip dislocation causes severe problems for the gait and static of the vertebral column. Here surgical treatment in early childhood (open reduction, intertrochanteric osteotomy and roof plasty, may produce an essential improvement, even if for a long term arthritis may be expected. But nowadays we have satisfactory techniques of arthroplasties with wear resistant ceramic selflocking prostheses for these cases. Besides on the CDH valuable surgical methods are available also in other hip diseases in early childhood (myelodysplasia, Perthes, cerebral palsy). Indication and surgery need special experience.

Cerebral Palsy↗

PubMedDate not supplied

[Development assessment of a hip ultrasonographic screening program for the early diagnosis of congenital hip dysplasia at the orthopedic university department Homburg/Saar from 1986 to 1990].

The results of the hip ultrasound newborn screening at the orthopaedic department of the University Hospital Homburg/Saar underline the necessity of an early diagnosis of Hip dysplasia already during the first days of life. In the course of the following publication the benefit of using abduction-pants in case of physiological unripe and primary pathological hips is described closely. From October 1985 to December 1990 2317 newborns have been examined by ultrasound. The rate of Hip Dysplasia (type IID, IIg, IIIa) was at 104 hips (2.2%). Clinical striking facts were only found in 46.3% of all patients with primary pathological hips. After an precautionary broad swadling (Breitwickeln) or abduction-pants-treatment 331 (90.0%) hips of the 368 regular checked hips with type IIa developed with an average secondary anatomical healing of 2.5 months to Ia- or Ib-hips. After 3 months only just 12 hips corresponded to a diagnosis of type IIb according to Graf. A deterioration to a IIg or IIIa hip was only ascertained in two cases. With all 41 sufficiently controlled primary pathological hips an improvement to type Ia or Ib according to Graf achieved when treated with abduction pants (average duration of treatment: 4.3 months). None of the children had to undergo an operation because of instable hips.

Braces↗

PubMedDate not supplied

[Medium-term results of cement-free autophor hip endoprosthesis].

Representation of middle-term observations of cementless ceramic THR (type Autophor) in a period of now nearly 18 years with altogether 1974 primary arthroplasties. The design of the conical shaped screwed ceramic socket proved to be very successful, its aseptic loosening rate amounted to 1.8% at last. We could confirm the favourable biocompatibility and wear behaviour of ceramic/ceramic joint pairing. The stem design had to be improved twice during the observation period due to upcoming aseptic loosening problems; the femoral component 900 S with macro- and microprofile, which has been in clinical use since 1984, shows an aseptic failure quote of less than 2% after 8 years. The very low average age of our patients with cementless THR at time of operation (48.9 years) proves, that--when using wear resistant biomaterials and surface enlarged prosthetic components to be implanted without bone cement--Charnley's strict age indication of THR may be abandoned.

Adolescent↗

PubMedDate not supplied

[Comparative biomechanical studies of conventional and self-tapping cortical bone screws].

In normal cortical screws the thread must be cut by a separate thread-cutter. So a high stability of the connection is achieved. On the other hand thread cutting needs time, which may be assumed to several minutes during a plate osteosynthesis. To avoid thread-cutting, self-tapping screws were used 20 years ago. These old self-tapping screws had a reduced stability and a lower torque at the final screw driving so that they tended to destroy the thread. By a modification of the cutting edges at the tip of the screw the tapping quality is increased decisively. The microscopic examination showed a better cutting of the new screws with little difference to a thread-cutter. In biomechanical tests the final torque and the maximum tension force of the self-tapping screws were at the same level as in usual pre-cut screws. In the practical use the new self-tapping screws have a good handling and save time during operation. In osteoporosis, they should be used carefully in order to meet the opposite corticalis' hole and not to destroy the ipsilateral corticalis' thread.

Biomechanical Phenomena↗

PubMedDate not supplied

[Replacement of the hip joint in young patients under 40 years of age. Clinico-statistical report of experiences].

At Orthopedic Department of Homburg/Saar University Clinic there were - between 1974 and 1985 - altogether 270 cementless total hip replacements by AUTOPHOR-arthroplasty in 243 patients, who were 40 years of age and younger at time of operation. The male patients mostly suffered from posttraumatic joint destructions or idiopathic femoral head necrosis, the female patients from dysplasia coxarthritis. In 43.3% there were previous hip operations in the past. 6 septic failures (5 times removal of prosthesis); 33 (12.2%) aseptic failures, mostly of the femoral component with following exchange operation. Clinical and roentgenological control of 170 cases (septic and aseptic failures excluded). Subjectively good and very good results in 82.3%. Evaluation of clinical datas acc. to the scheme of Merle d'Aubigné. Improvement of preoperative situation (5.4 points average) to 14.7 points average postoperatively. In most of the patients, a professional and social integration could be achieved; only 28 patients received a pension. With regards to the functional inferior alternatives of resection hip rsp. hip arthrodesis, THR by cementless prostheses in young patients with severe joint destructions seems to be justifiable and recommendable - according to our medium-term results.

Adolescent↗

PubMedDate not supplied

[Skeletal changes in thalassemia].

Display of this hereditary blood disease (haemoglobinopathy) which is endemic in the Mediterranean area and rarely appearing in our area, characterized by early blood cell destruction and increasing transfusion siderosis of internal and endocrine organs, secondary osteoporosis, epiphyseal growth disturbances and spontaneous fractures by means of two typical cases.

Adolescent↗

PubMedDate not supplied

[Incidence and start of inpatient treatment of pediatric hip dislocations in West Germany].

A national report of hospitalized children with cdh (up to the 6th year of age) (treated in 1983) is presented. 196 (63.1%) of all university hospitals and orthopaedic departments took part in this statistic. The number of all collected children was 1172,888 of them had a hip dislocation. Hospital treatment of children with a dislocated hip started on the average in the age of 9 months, that means much to late. Only 4.1% of the children showed neurological symptoms. The patents are reported in detail. The presented data lead to the conclusion, that the actually performed legal examination of children is insufficient for early detection of cdh. A general orthopaedic clinical and ultrasound examination in the first week of life should be introduced.

Acetabulum↗

PubMedDate not supplied

[Hip joint replacement in young patients].

The recent standard of hip-joint replacement after Charnley with metal-polyethylene combination and fixation by bone cement is charged with long term problems by wear (with foreign body reaction) and cement destruction by fatigue. Therefore the indication was limited to old patients with short life expectancy and left the problem of joint replacement in younger patients unresolved. By the use of highly wear resistant alumina ceramic and return to cementless anchorage, according to the principle of surface increase, a new technique of joint replacement by means of selflocking ceramic-autophor-prosthesis was created. The clinical experience is now 9 years. It shows that after some problems in the beginning mostly good results can be achieved. Therefore an extension of the indication for joint replacement for younger patients is justified.

Adolescent↗

PubMedDate not supplied

[Lunate malacia and its treatment with lunate excision].

The malazie of the Os lunatum ist one of the most frequent aseptic bone-necroses. It is found mainly with patients between the age of 25 and 35 years. That means that most of our patients are working full time. We give a clinical report of the disease and discuss the different aetiopathogenetic mechanisms according to the literature. In addition we give a cronological survey over possible methods of treatment both conservative and operative. We describe our method of treatment introduced by Mittelmeier (1965). In this method the gap that arises by resection of the Os lunatum is filled with a helved piece of soft tissue. This filling-material consists of a volar helved piece of the joint-capsula and of epitendinosus tissue of the deep flexor-tendons. In the Orthopaedic University Hospital in Homburg/Saar we have a casuistic of 42 cases treated by this method. This is the biggest casuistic in the literature as fare as we know. We report our results of treatment based an a clinical and X-ray examination. With this method we had satisfying longterm results in 80% of the cases. Even after years we hardly found an arthrosis between Os naviculare and radius. According to these results we recommend the method after Mittelmeier for the treatment of the malazie of the Os lunatum even for severe cases with fragmentation and collaps of the Os lunatum.

Adolescent↗

PubMedDate not supplied

[Follow-up results following Matti-Russe grafting in navicular pseudarthrosis].

The navicular pseudarthrosis is in case of early and appropriate treatment of the navicular fracture relatively seldom. It develops often after a too late diagnosed or insufficiently treated navicular fracture. After an introduction of the pathogenetic causes of the navicular pseudarthrosis we give a survey over the operative methods of treatment represented in literature favourising the method of the implantation of a corticospongious bone-graft after Matti in the modification of Russe, which we prefer in our hospital. We base the long-term results of our treatment on a casuistic of 105 patients, operated after the method Matti-Russe. We performed a follow-up of 68 patients between 3 and 16 years after the operation (8,4 years on average). In our critical examination we put stress on the functional results, on the subjective and objective sucess of the operation, on the professional situation of the patients and its social-medical meaning. At last we give a comparison with the most extensive casuistics of the literature.

Adult↗

PubMedDate not supplied

[Joint saving operation procedures in idiopathic femur head necrosis].

At first, this report deals with the characteristics of the idiopathic necrosis of the femoral head and the possibilities of operative treatment specially in the sense of saving the hip-joint. Beside old techniques of sanitation of the focus, nowadays the femoral osteotomy, mainly in the sense of a flexion-osteotomy is well to the fore. Hereby, the necrotic area can be turned out of the main loaded part of the hip-joint. We recommend a combination of femoral osteotomy with a ventral capsulotomy and tenotomy. Furthermore, there should be a sanitation of the focus, above all by drilling. Then we report about our experience with this operative treatment. 37 cases out of 52 were controlled clinically and roentgenologically. The subjective results were very good to fair in about 85%, the functional improvement of the hip-joint was mostly good. On the other hand, there was a difference between clinical and roentgenological results, we found an improvement of the necrotic destruction of the femoral head only in 28%. We mainly noticed poor subjective and objective results in cases of too extended necrotic areas, of too advanced stage of necrosis and of secondary coxarthrosis. In those cases we refer to the differential indication of the total hip-arthroplasty.

Adolescent↗

PubMedDate not supplied

[Results of infection prevention in hip joint alloarthroplasty with cefamandole].

With regard to the unsatisfactory number of infections after total hip replacement operated in conventional operating rooms the problems of antibiotic prophylaxis has been discussed for years but has remained contested until today. We tested the efficiency of a peri- and postoperative prophylaxis of Cefamandole (Mandokef) on a non selected collective of 384 patients undergoing total hip replacement during a period of exactly two years. The results of these patients were compared to those of a preceded comparable collective of 319 patients who did not have a perioperative antibiotic prophylaxis. Cefamandole was given 4.6 postoperative days on the average. Compared to the collective of 319 patients there was a significant reduction of secondary healing in the "cefamandole-collective" from 3.1% to 0.8%. The number of deep infections were reduced from 3.8% to 0.8%. Allergic side effects of the antibiotic could be reduced from 12.5% ("secondary" prophylaxis sometimes applied to patients of the first collective) to 1.3% ("cefamandole-group"), the mycosis rate was reduced from 3.8% to 1.8%. There were no grave complications of the cefamandole-prophylaxis, not even effects on the microclimate of the hospital. Two of the three infected hip arthroplasties (prophylaxis-group) could be saved by a second operation when putting a through-drainage and giving a special antibiotic treatment. The prosthesis had to be removed only in one single case (0.3%). Beside the importance of a prophylactic antibiotic treatment we point out the efficiency of a clean air system, furthermore, these two procedures are economically justifiable.

Cefamandole↗