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Biomedical subjects

L Jani

Publications and source records attributed to L Jani.

At least 19 recordsLinked to original sources
PubMed2002

[Management and treatment results for acute slipped capital femoral epiphysis].

The priorities in treating an acute slip are to avoid avascular necrosis and chondrolysis. Other aims in the unstable situation are to prevent further slip and to correct deformity. We reviewed the management of 16 unstable slips after nearly 9 years. Fifteen patients underwent reduction and stabilization with K wires within 24 h of the onset of severe symptoms. Only one patient in this group developed avascular necrosis (6.6%) and in no case was chondrolysis seen. No correlation was noted between slip magnitude and the development of avascular necrosis. Therefore, we recommend in cases of unstable slips early reduction and stabilization to reduce the risk of avascular necrosis and chondrolysis.

Acute Disease↗
PubMed2002

[Results of treating slipped capital femoral epiphysis by pinning in situ].

The primary aim in treatment of chronic SCFE consists of immediate stabilization of the epiphysis to prevent further slipping. For mild degrees of slipping (<30 degrees ), pinning in situ is the treatment of choice. With slips between 30 and 50 degrees, the decision should be based on individual factors (age, functional limitation of the hip joint) whether pinning in situ is sufficient or whether an additional intertrochanteric osteotomy according to Imhäuser should be performed.The choice of implant should ensure a safe and stable connection between the epiphysis and the femoral neck without resulting in a substantial impairment of growth of the femoral neck due to premature closure of the growth plate. Since 1982 we have used K wires for in situ pinning of the affected hip as well as for prophylactic pinning of the nonaffected hip with a low complication rate. In a clinical and radiological study, 65 patients with a chronic slip of less than 50 degrees could be assessed after in situ pinning. Almost 75% were pain-free after a follow-up interval of 9.8 years, and 92% achieved a good or very good result according to the criteria of the Iowa hip score, the mean score being 95.1 points. According to the radiological score of Schulitz, five patients (7.7%) demonstrated a grade I osteoarthritis. One patient showed a partial necrosis of the femoral head; chondrolysis was not observed.

Adolescent↗
PubMed2002

[Significance and results of subcapital osteotomy in severe slipped capital femoral epiphysis].

Today treatment with in situ fixation for mild slips in chronic SCFE is undisputed. However, it is far more difficult to give a definite recommendation in cases where a severe dorsal slip of >70 degrees has already occurred. With this position of the femoral head, a severe functional deficit combined with an early onset of osteoarthritis has to be expected. With these severe slips we prefer the subcapital osteotomy, a technique which results in an almost normal anatomical alignment of femoral head and acetabulum. In the literature, this procedure is subject to controversy because of the relatively high incidence of avascular necrosis and chondrolysis. In our own small collective of five patients, we did not observe these complications in the postoperative follow-up and the clinical results were excellent. After 8.5 years the Iowa score was a mean of 91.8 points. Only one patient showed radiological signs of grade I osteoarthritis; the follow-up interval was, however, relatively short.

Adolescent↗
PubMed2001

[Long-term results with the cement-free Spotorno CLS shaft].

This retrospective study reviews 298 sequential cementless CLS Spotorno stems, which achieved their primary fixation and bony in- or ongrowth predominantly in the metaphyseal region. The minimum follow-up was 10 years and the average follow-up 11.7 years (range 10-14). The mean age at surgery was 55.2 years (range 32.2-68.9). Of the patients, 76.2% (227 stems) were followed up: 172 patients (57.7%) underwent clinical and radiological examination and 52 patients (55 stems, 18.5%) were interviewed by telephone. Of 298 stems, 13 (4.4%) had been replaced in the mean time, only 6 stems (2.0%) because of an aseptic loosening. The evaluation included both clinical (Merle d'Aubigne and Harris hip score) and radiographic parameters (plain X-rays). The mean Merle d'Aubigne score was 16.7 points, and the mean Harris hip score was 94.3 points. Radiolucent lines were detected in 33.7%; 5.8% showed enlargement within the last 3 years. Focal osteolyses were present in 30.8% of patients; 2.9% had progressed within the last 3 years. At follow-up, one patient presented with new clinical and radiological evidence of aseptic stem loosening. The current study showed an aseptic loosening of the CLS stem in 2.3%, a good osseointegration and good functional score results in more than 90%. The primary fixation and bony in- or ongrowth predominantly in the metaphyseal region seems to achieve good clinical results. Wear is the main reason for the osteolytic changes. Frequent clinical and radiological follow-up is important to detect bone reactions and loosening of the stem.

Adult↗
PubMed2001

Mid-term results of the cementless CLS stem. A 7- to 11-year follow-up study.

Between 1986 and 1990, 335 primary total hip arthroplasty (THA) were performed using the cementless CLS stem. The mean age at surgery was 55.3 years. The retrospective study was performed at an average follow-up time of 8.9 years. A total of 232 patients (69.3%) underwent clinical and radiological examination, 33 patients (9.9%) were interviewed by telephone, and 9 stems (2.7%) had been replaced meanwhile. The mean Harris hip score was 91.7 points, and the mean Merle D'Aubigne score was 16.8 points. One stem had subsided during the first postoperative year. Ectopic ossifications classified as Brooker III were noted in 5.7%, with no Brooker IV being seen. Radiolucent lines were found in 43.5%, and 11% showed enlargement with time. Focal osteolyses were present in 36%, of which 24% progressed with time. At the latest follow-up, we did not find any stem loosening clinically or radiologically.

Adult↗
PubMed2000

[Simulator for migration processes and wear in the artificial hip acetabulum for radiologic measurement].

For assessing migration of cups, standard X-rays or stereo radiological images (SRI) are available. In addition, software is also available for measurements. The accuracies of the various systems are established statistically, in part combined with phantoms, and compared. To date, no known phantom is available for the simulation of acetabular cup migration with account being taken of the position of the pelvis in the X-ray beam. Such an appliance covering 8 different parameters has now been developed, the cup can be moved horizontally, vertically and in the loading direction. Angular accuracy is +/- 0.5 degree, and wear of a magnitude of 0.25 mm can be simulated. Two degree elevation of the pelvis, left or right, can be simulated. The position of the pelvis around the horizontal axis permits continuous variation. This appliance can simulate migratory movements of the acetabular cup within a pelvis, and wear within the cup. In addition, the spatial position of the pelvis can be varied. The X-ray images can be used to investigate the accuracy of evaluation strategies.

Acetabulum↗
PubMed1999

[Guidelines in orthopedics. Alliance of German Orthopedists. University Clinic of Orthopedics, Heidelberg].

Guidelines are systematically developed statements of the actual knowledge in order to assist doctors and patients by the decision of appropriate health care. Since 1998 the DGOT has published 22 well structured guidelines, 20 guidelines are under construction. The AWMF as the coordinator of guideline constructing of all scientific medical societies has published 629 guidelines since 1995. The publication of guidelines of the DGOT and the BVO is the first step for dissemination, next steps should be implementation und evaluation. Then it will be evident whether change in medical practice will occur.

Evidence-Based Medicine↗
PubMed1999

Simulator trials to determine the wear of the combination aluminium oxide ceramic-carbon fibre reinforced plastic (CFRP) used as an insert in a hip socket.

Hip simulator trials were conducted to determine the initial wear between alumina femoral heads and carbon fibre reinforced plastic (CFRP, CAPROMAN) insert in a titanium socket. A force of 2500 N and a frequency of 0.857 H were applied. Using surface and sphericity measurement techniques, the amount of wear was determined. After 500,000 cycles, the centre of the head had moved by 10 microm into the insert, and the average radius increased by 2 microm. After 1 million cycles, the additional changes were less than 1 microm. Based on an examination of retrieved implants (wear rate: 6.1 microm/year) and based on the simulator results, the combination alumina-CFRP inserts could be approved for total hip replacement.

Biomechanical Phenomena↗
PubMed1998

Advantages of patellar resurfacing in total knee arthroplasty. Two-year results of a prospective randomized study.

Complications of patellar resurfacing in total knee arthroplasty have rekindled the interest of many surgeons in patellar retention. In a prospective study 20 randomly selected patients of 40 underwent patellar resurfacing in combination with their total knee arthroplasty. The other 20 patients were left with an unresurfaced patella. Within 24 months of follow-up, the advantages of patellar resurfacing could be seen according to the Knee Society Score. Especially in advanced osteoarthritis of the knee joint, the patients achieved better scores in climbing stairs and in function. The superior functional results are arguments for patellar resurfacing, at least in knees with advanced osteoarthritis.

Aged↗
PubMed1998

[Review of the results of the ARO multicenter study].

The ARO multicenter study intended to show clinical and radiological differences with regard to different systems of fixation and designs of the prothesis in total hip replacement in patients with hip dysplasia, osteoarthritis and rheumatoid arthritis. In 1987 and 1988 5255 total hip prothesis were implanted by the 24 hospitals which took part in the study. 3133 prothesis (95.6%) were clinically and radiologically examined. The follow-up period averaged 6.9 years. The results of the Aro multicenter-study showed that despite difficult preoperative conditions especially in cases of rheumatoid arthritis the satisfaction rate improved remarkably. During the operation less complications arose in comparison to patients with hip dysplasia and osteoarthritis. Regarding the rate of infection after operation there were no differences between the 3 groups. Only the rate of post-operative luxation concerning rheumatoid patients turned out to be twice the number of the others. In our opinion this is due to the fact that these rheumatics were operated by posterior approach. Patients with rheumatoid arthritis were satisfied most with their surgeries. Results of rheumatic patients according to Harris hip score were slightly worse than the results of the two other groups. This was due to systemic involvement and bad preoperative function of the hip. As a result of the study there were no differences in using cemented or cementless techniques for rheumatic hip replacement. The decision for the method of fixation should depend on the patient's ability to relief the prothesis after operation. The study has shown that cementless implantation can also be used for young rheumatics provided that a suitable design of prothesis will be selected.

Arthritis, Rheumatoid↗
PubMed1998

[Radiologic results of the ARO multicenter study].

We present the radiological results of 2286 total hip replacements (THR) from the multicenter study. Concerning the acetabular component the analysis showed that socket migration and radiolucent lines were much more dependent on the specific design of the socket than on the primary diagnosis. A similar results was found for the femoral stems: rheumatoid arthritis did not cause a higher percentage of stem subsidence, radiolucent lines or bone remodeling. Within a mid-term follow-up period the reduced bone quality in rheumatoid arthritis is not associated to premature failure of a cemented or cementless prosthesis. THR failure seems to be more dependent on specific construction features of the individual socket and stem.

Arthritis, Rheumatoid↗
PubMed1998

[Implant failure after total hip replacement. Comparison of patients with primary coxarthrosis, rheumatoid arthritis and dysplastic coxarthrosis].

The analysis of THR-failures showed that the acetabular component still is the main problem of total hip replacement. The acetabular cup fails more often than the stem. In the midterm analysis the failure rate is a little bit higher in cementless than in cement fixed cups. The known effect that the failure rate of cups fixed with cement increases exponentially 8 to 10 years after implantation, could of course not be seen in this study. The success of the cementless fixation was negatively influenced by the diagnosis rheumatoid arthritis, age over 70 and the fixation manner: the failure rate of threaded cups was higher than the one of press-fit cups although the Zweymüller-cup as well as the Link type V-cup showed good results. The midterm results of the stem were very good for the cementless as for the cemented technique. Some implants showed compared to others significantly worse results. The further implantation should be thought of, what partially has already happened. The results of cementless stem fixation in patients with rheumatoid arthritis, osteoarthrosis and dysplastic osteoarthritis is comparable, so that cementless fixation should be thought of in case of adequate conditions (ability of partial weight bearing for some weeks, age under 60).

Aged↗
PubMed1998

[Patellar resurfacing. Results of a prospective randomized study].

The mid-term results of this prospective randomized study illustrate why it is difficult to define a clear position concerning the issue of patellar resurfacing in total knee arthroplasty. In both groups of 20 patients typical complications for the respective procedures have occurred. One patient from group A with patellar resurfacing had to be revised for loosening of the patellar implant. In group B without resurfacing 3 patellae subluxated, 2 having been revised. Furthermore 4 patients complained about mild to moderate anterior knee pain. The Knee and Function Scores of the patients without revision were not significantly different except for the parameter pain (Knee Score Gr. A:84.8, Gr. B:77.8; pain Gr. A:46.9, Gr. B:41.9; Function Score Gr. A:78.5, Gr. B:71.9; climbing stairs Gr. A:38.5, Gr. B:33.8). The radiological measurements found the patellae with resurfacing significantly less tilted with 3.8 degrees than the patellae without resurfacing with 6.4 degrees. With the correct implantation technique patellar resurfacing guarantees a good clinical result within the first 5 years. Leaving the patella unresurfaced was associated with a higher rate of anterior knee pain and revision in our study.

Aged↗
PubMed1997

[Primary chronic osteomyelitis].

The term primary chronic osteomyelitis covers a heterogeneous spectrum of clinical features that should be separated for therapeutic reasons. Unifocal manifestations should be distinguished from multifocal ones. While bacteria are often found in the first group, bacteriological investigations are usually negative in the second group. Additionally, multifocal forms often recur (chronic multifocal recurrent osteomyelitis), possess a long clinical course and may be combined with dermatological disorders (SAPHO syndrome). A biopsy is often necessary for tumor exclusion and obtaining material for bacteriology. Histology cannot differentiate between the respective forms of chronic osteomyelitis.

Biopsy, Needle↗