Biomedical subjects

K Tallroth

Publications and source records attributed to K Tallroth.

At least 55 records · Page 3Linked to original sources

PubMed1990

Cementless revision of aggressive granulomatous lesions in hip replacements.

In 16 patients we used uncemented Lord prostheses at revision operations for aggressive granulomatosis after cemented hip arthroplasties; in 12 bone grafts also were used. In 13 hips the granulomatous lesions were multifocal, and in one the acetabular component was involved. There was no evidence of infection in any case: all the patients had normal ESR and CRP levels. The revision operation was performed on average 9.4 years after the primary replacement; the mean age at revision was 64 years. On radiographs, the bone around the prosthesis had consolidated by an average of 16 months. At follow-up, two to six years later (mean 3.5 years) there had been no recurrences, nine patients had an excellent Mayo hip score, five were good and two fair.

Adult↗

PubMed1990

Clinical relevance of discography combined with CT scanning. A study of 100 patients.

Two different classifications of discograms have been used in a prospective study of 279 injected discs in 100 patients. The five-stage classification of Adams, Dolan and Hutton (1986) showed increased degeneration in the lower lumbar discs and more degenerative changes in men than in women. Exact reproduction of the patient's pain on injection was more common in fissured or ruptured discs than in less degenerate discs, with 81% sensitivity and 64% specificity of the discogram for pain. The additional information obtained by comparing computerised tomography (CT) with discograms was minimal. Discography was found to be useful in the evaluation of chronic low back pain in patients whose ordinary CT scans, myelograms and flexion-extension radiographs were normal. In spondylolysis and spondylolisthesis, discography can disclose whether fusion needs to be extended above the lytic level, and it may show if the pain in patients who have had posterolateral fusion is discogenic. Thus, discography gives information which is useful in deciding whether to operate on patients with chronic low back pain.

Adolescent↗

PubMed1990

Aggressive granulomatous lesions in cementless total hip arthroplasty.

We describe six patients with aggressive granulomatous lesions around cementless total hip prostheses. Two patients previously had a cemented prosthesis in the same hip. The Lord prosthesis was used in five patients, the PCA in one. Both prostheses were made of chrome-cobalt alloy. Pain on weight-bearing occurred on average 3.2 years after the cementless arthroplasty, and at that time radiography revealed aggressive granulomatosis around the proximal femoral stem and the acetabular component in five of the patients; one had a large solitary granuloma in the proximal femur. Revision was performed on average 4.8 years after the cementless arthroplasty. At that time all granulomas had grown large in size; while waiting for revision operation, two femoral stem components fractured. All the granulomas showed a uniform histopathology, which included histiocytosis; the cause for these lesions was thought to be plastic debris from the acetabular socket.

Acetabulum↗

PubMed1990

Aggressive granulomatous lesions associated with hip arthroplasty. Immunopathological studies.

The local immunopathological response was analyzed in six patients who had a revision of a total hip prosthesis because of an aggressive granulomatous lesion and in six patients who had a revision because of common loosening of the prosthetic stem. All twelve patients had had a total replacement arthroplasty for primary osteoarthrosis. All of the prostheses had been cemented. The aggressive granulomas consisted of well organized connective tissue containing histiocytic-monocytic and fibroblastic reactive zones. The granulomas were highly vascularized, and villous structures were observed at many sites. In contrast, the areas around the loose cemented stems were characterized by dense connective tissue. Immunohistological evaluation revealed that most of the cells in the aggressive granulomatous tissue were multinucleated giant cells and C3bi-receptor and nonspecific esterase-positive monocyte-macrophages. This cytological finding suggests a foreign-body-type reaction, compatible with the rapidly progressive lytic nature of the lesion that was shown radiographically. There was a clear-cut difference between aggressive granulomatosis and the more common lesion accompanying prosthetic loosening--namely, the relative lack of activated fibroblasts in granulomatosis. We suggest that granulomatosis involves an uncoupling of the normal sequence of monocyte-macrophage-mediated clearance of foreign material and tissue debris that is normally followed by fibroblast-mediated synthesis and remodeling of the extracellular matrix. We also suggest that aggressive granulomatosis in association with a cemented hip prosthesis is a distinct entity, not only clinically and radiographically, but also histopathologically.

Aged↗

PubMed1990

[Myelography, computerized tomography and electromyography in intervertebral disk diseases of the lumbar spine].

Fifty-five patients who underwent lower spine surgery were preoperatively evaluated with myelography and postmyelography CT. ENMG was done on 23 patients. CT had the highest accuracy in finding the affected level (F = 75,5; p less than 0,0005) as compared to myelography (F = 46,5; p less than 0,0005) or to ENMG (F = 11,4; p greater than 0,15). We did not find statistical differences in diagnostic accuracy in different disc spaces nor was there a difference between primary and recurrent low-back disease.

Adult↗

PubMed1990

Measurement variations in scoliotic angle, vertebral rotation, vertebral body height, and intervertebral disc space height.

Thirty consecutive posteroanterior and lateral radiographs of patients with adolescent idiopathic scoliosis with a mean Cobb angle of 24.4 degrees were read. In measuring the scoliotic angle, the interobserver error (SD) was 2.8 degrees and the intraobserver, 1.8 degrees. Rotation of the apical vertebra was estimated by measuring the translation of the pedicle on posteroanterior radiographs. For vertebral rotation, the interobserver measurement error (SD) was 3.4 and the intraobserver, 1.8%. The height of the apical vertebral body and the intervertebral disc space next inferior to it were measured on lateral radiographs as the anterior angles of the diagonals of the respective body or disc space. In measuring the vertebral body height, the interobserver error (SD) was 3.2 and the intraobserver, 2.6 degrees, and in measuring the intervertebral disc space height, the interobserver error was 2.4 and the intraobserver, 1.8 degrees. The angles can be transformed to a corresponding height/length ratio by a simple trigonometrical formula.

Adolescent↗

PubMed1989

Leg-length inequality has poor correlation with lumbar scoliosis. A radiological study of 100 patients with chronic low-back pain.

Leg-length inequality and its hypothetical consequences, pelvic tilt and lumbar scoliosis, were measured in 100 young or middle-aged adults suffering from chronic low-back pain. Leg-length inequality had a good correlation with the pelvic tilt assessed from the iliac crests, a moderate correlation with the sacral tilt, but a poor correlation with the lumbar scoliosis. The sacral tilt correlated well with the lumbar scoliosis when the tilt was more than 3 degrees but poorly when it was smaller. Thus, there is a gradually decreasing correlation between the posture parameters when moving from the hips up to the lumbar spine. We conclude that before a radiologically observed leg-length inequality be considered as the cause of low-back pain, an erect-posture radiograph of the whole pelvis and lumbar spine is essential, in order to assess an existing pelvic tilt and scoliosis.

Adult↗

PubMed1989

Calcitonin treatment in lumbar spinal stenosis: clinical observations.

The prognosis of patients with lumbar spinal stenosis is usually considered poor, and they often need decompression surgery. This study investigates the clinical efficacy and safety of intramuscular calcitonin therapy in 15 lumbar spinal stenosis patients with a neurogenic claudication syndrome. The study is based on several tests used to measure the patient's physical performance capacity. Calcitonin had some beneficial effects on the patients without appreciable side-effects. Because of possible placebo effect, a double-blind cross-over study has been started.

Adult↗

PubMed1989

Trunk asymmetry and scoliosis, Anthropometric measurements in prepuberal school children.

A total of 1060 children (515 girls, 545 boys) were examined for screening of trunk asymmetry ans scoliosis at an average age of 10.8 years. The physical examination consisted of height, sitting height, total arm length and leg length inequality determinations and moiré topography. Trunk asymmetry was measured by forward bending test and a posteroanterior standing radiograph of the spine was taken of those 188 (17.7%) children who had a trunk hump greater than or equal to 6 mm. Only 20.1% of the children were found to be exactly symmetric in the forward bending test, 47.3% had a right-sided hump and 32.6% had a left-side hump. Humps of 6 mm or more were significantly (p = 0.03) more prevalent among girls (21.7%) than boys (16.3%). Moré fringe asymmetry was provided to be common: only 9% of the material was totally symmetric, two thirds has asymmetry of less than or equal to 1 fringe, 26.6% has asymmetry greater than 1 and less than or equal or 2 and 5.4% greater than 2. The prevalence of scoliosis (trunk hump greater than or equal to 6 mm and Cobb angle less than or equal to 10 degree) was 4.1%. The majority (72.1%) of the curves were left convex.

Anthropometry↗

PubMed1989

Aggressive granulomatous lesions after hip arthroplasty.

We reviewed 19 patients who presented with aggressive granulomatosis around the femoral stem after hip replacement. All had experienced stress pain and had required revision arthroplasty on average 8.8 years after the primary operation. Fifteen patients were men and four were women; none had rheumatoid arthritis. One patient had an uncemented Moore hemiprosthesis; the others all had cemented total hip replacements. When first detected, the granulomatous lesions were multifocal in 13 patients. The first granuloma was in the region of the lesser trochanter in 10, and near the tip of the stem in only two. Speed of growth varied but on average there was doubling of the area on anteroposterior films in 2.2 years (range 6 months to 4.6 years). Aggressive granulomatous lesions in replaced hips are a distinct condition, different from simple loosening or infection; the lesions may grow rapidly, so revision surgery is indicated soon after diagnosis.

Adult↗

PubMed1988

Cementless total replacement for old tuberculosis of the hip.

We report the results of cementless total joint replacement in 18 patients with old tuberculosis of the hip, performed, on average, 34 years after the onset of infection. Mean follow-up was 3.5 years. Only seven of the patients had antituberculous drugs during or after the operation. Using the Mayo hip score, 15 patients had excellent or good results and two had a fair rating. One patient had the prosthesis removed more than one year postoperatively for late haematogenous staphylococcal infection and had a poor rating. All the patients had relief of hip-related pain. Despite the absence of any reactivation of tuberculosis in our series, we recommend the use of specific prophylaxis.

Adult↗

PubMed1988

Arthroplasty for old tuberculosis of the knee.

We have reviewed six patients with old tuberculosis of the knee treated by total replacement an average of 35 years after the primary infection. Three patients had no antituberculous prophylaxis and three had drugs for two to three weeks before and three weeks after the operation. One patient with a missed primary diagnosis had a relapse of the tuberculous arthritis 18 months after his arthroplasty and was successfully treated with antituberculous drugs for one year. At an average follow-up of 6.3 years all the patients were markedly improved. Old tuberculosis of the knee can be treated successfully with arthroplasty but there is a risk of reactivation of disease and prophylactic drugs are recommended.

Adult↗

PubMed1988

Total hip replacement in old tuberculosis. A report of 14 cases.

We treated 14 patients with a cemented total hip replacement for old tuberculosis on an average 43 years after the onset of the coxitis. Nine patients were not given any antituberculous treatment, whereas in 5 patients treatment with antituberculous drugs was administered postoperatively for 6 to 12 months. The duration of postoperative follow-up was on an average 8 (5-10) years. Using the Mayo hip scoring system, 8 of the patients were classified as excellent or good, 3 as fair, and 3 as poor. The poor results were in 2 cases due to aseptic loosening of the prosthesis and infection in 1. None of the patients showed reactivation of the tuberculosis.

Antitubercular Agents↗

PubMed1987

Stress radiographs in the evaluation of degenerative femorotibial joint disease.

Thirty-eight osteoarthrotic knees were examined to assess the widths of the femorotibial joint spaces. Radiographs were exposed with the patient lying, in a standing position, and with an adduction and abduction force. Forced compression of the osteoarthrotic joint compartment caused, on average, 18% greater narrowing than when loading it in the standing position. Compared to the joint space at rest, the non-weight-bearing compartment widened by 16% in the standing position and narrowed by 20% when stress was applied. Furthermore, the results showed an increase in laxity proportional to the degree of arthrosis. Stress radiographs significantly display the real cartilage width of both joint compartments. Knowledge of the condition of the articular cartilage in the non-weight-bearing compartment is important when considering a transfer of loading stresses by means of osteotomy.

Adult↗

PubMed1987

Silicone implant arthroplasty in Kienböck's disease.

Fifty-five patients with malacia of the carpal lunate treated by Swanson's silicone implant arthroplasty were reexamined. The follow-up period averaged 3 years. The operation had a favorable effect on pain, but the range of motion and the grip strength remained impaired. Arthrosis progressed in half the cases, and there were five dislocations of the implant and 11 cases of cystic changes of carpal bone.

Adult↗

PubMed1986

Comparison of iohexol and meglumine iothalamate in single contrast knee arthrography. A double-blind investigation.

A prospective double-blind study was performed to assess the side effects and visualization quality of 2 contrast media, iohexol and meglumine iothalamate in single contrast arthrography. There were very few adverse reactions during the examination. During the 2 days after arthrography pain occurred in about 29% of each group. Iohexol caused somewhat less delayed pain on movement and fewer sensations of swelling than iothalamate. The quality of the arthrograms was significantly better with iohexol both in films taken immediately after injection as well as after 20 minutes.

Adolescent↗

PubMed1986

Leg length inequality after total hip arthroplasty.

Leg length inequality (LLI) in 55 patients with cemented total hip arthroplasty (THA) was measured from weight-bearing anteroposterior (AP) hip radiographs. The mean radiologic LLI was 8.7 mm in unilateral and 11.6 mm in bilateral THA, differing significantly from the clinically measured values (2.8 mm and 4.2 mm, respectively). LLI as a cause of aseptic loosening and unexplained pain warrants investigation in THA patients.

Adult↗

PubMed1985

Weight-bearing radiography in total hip replacement.

Serial anteroposterior (AP) radiographs of the weight-bearing pelvis and hips were taken of 29 patients with total hip replacement (THR). For constant positioning the patient stands with straight knees on a board with a block between the heels. A U-shaped mercury level strapped to the patient provides a horizontal reference line on the radiograph. On the average, individual variation of pelvic tilt in serial films was 1 degree and pelvic rotation 3.5 degrees confirming satisfactory reproducibility. The horizontal reference enables estimation of pre- and postoperative leg length inequality (LLI) and of the angle of the acetabular cup (AA). Reproducibility allows assessment of the exact position of the femoral component and quantitative evaluation of radiolucency and bone resorption around the prosthetic implant in the follow-up of THR.

Hip Prosthesis↗