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Biomedical subjects

N Gschwend

Publications and source records attributed to N Gschwend.

At least 55 records · Page 3Linked to original sources
PubMed1988

[Late results of the Colonna arthroplasty].

A long term follow-up study (20-26 years after the original surgery) is presented of 7 patients who underwent a capsular arthroplasty according to the method of Colonna for congenital hip dislocation. Clinically and, in part also radiologically, the results were amazingly good. If we respect a few essential rules before, during and after the operation, all aiming at avoiding hyperpressure in the hip joint, the Colonna procedure may still be an alternative to more modern reconstructive procedures of the acetabulum. This is particularly true for congenital dislocations in the older child or unsuccessfully treated high residual subluxations. In both cases the cartilage of the acetabulum is altered and deformed to such an extent, that no method can make it fit the femoral head, which is also deformed.

Acetabulum↗
PubMed1988

Supracondylar fractures of the femur adjacent to resurfacing and MacIntosh arthroplasties of the knee in patients with rheumatoid arthritis.

Twelve cases of supracondylar fracture of the femur in rheumatoid arthritis patients with previously implanted resurfacing or MacIntosh arthroplasty of the knee had long standing severe polyarticular rheumatoid arthritis (duration, ten to 41 years; mean 24.8 years). The fractures occurred following a long interval after implantation of the prosthesis (five to 204 months; mean, 92.3 months). Two fractures were treated by stable and two by unstable fixation; eight were treated nonoperatively. The fractures healed in a normal time with one exception, but the femur was shortened in ten cases (mean, 2.8 cm), and axially malaligned in nine. The ability to walk long distances decreased in eight cases and pain increased in seven; two prostheses were loosened and displaced. Because of the poor results of nonoperative management, internal fixation of these fractures is recommended in selected cases.

Adult↗
PubMed1988

Semiconstrained elbow prostheses with special reference to the GSB III prosthesis.

Fully constrained metal-to-metal elbow prostheses are not used anymore because of a high loosening rate. Today semiconstrained or condylar prostheses are the two possibilities when replacement of a destroyed elbow joint is considered. A careful analysis of the most recent publications in the world literature reveals a high complication rate for both types of prostheses, each one having specific advantages and disadvantages. The Gschwend-Scheier-Bähler (GSB) III prosthesis is a semiconstrained prosthesis, requires little bone resection, and is therefore easily salvaged. The results in regard to pain relief and improvement in range of motion are satisfactory in a high percentage of patients. The rate of lasting complications is lower than with most of the other prostheses. The authors' transtricipital approach is also a factor that contributes to the high success rate. In case of a failed arthroplasty the authors' method of reconstructing the humeral condyles allows a better salvage.

Adult↗
PubMed1987

Changes in local bone density after knee arthroplasty. The use of quantitative computed tomography.

Loosening is a serious problem in total arthroplasty and early detection of bone loss in the vicinity of an implant would help in its investigation. We present a method for the objective evaluation of bone adjacent to metallic implants in which a modified technique of quantitative computed tomography (QCT) is used to reconstruct cross-sectional images with few artefacts. We have used this technique in 19 patients with knee arthroplasties to monitor the changes in bone density around the tibial stem of the prosthesis. In the first weeks after operation all patients showed a decrease in bone density ranging from 0.4% to 3.6% per month. One year after arthroplasty bone density had stabilised and only minor changes were observed. Our work indicates that modified QCT is a sensitive method for the long-term monitoring of the anchorage of implants and allows the early detection of osteolytic changes.

Aged↗
PubMed1987

[Arthrodesis following knee arthroplasty].

In 44 failed total arthroplasties of the knee joint, arthrodesis was attempted (1970-1986). The interval between implantation of the total knee arthroplasty and diagnosis of infection was more than 2 years on average. Removal of the arthroplasty and arthrodesis was performed about 1 year later. In 80% of the knees, compression arthrodesis using an AO plate was used 34 times, with solid fusion occurring after 6 months. External fixation was used in 10 patients; rate of solid fusion was only 60%. The reasons for delayed union or failure had to do with reduced bone stock in the metaphysis with poor bone quality, inadequate fixation, and uncontrolled infections.

Arthritis, Rheumatoid↗
PubMed1987

[Reconstructive plastic surgery of the humeral condyles following removal of endoprostheses of the elbow versus arthrodesis].

The condyles of the elbow are of utmost importance for the stability of this joint. This is particularly evident in cases where elbow prostheses had to be removed because of loosening or infection and where the condyles had been deliberately resected at the primary operation. In order to obtain a functional elbow with sufficient stability and mobility after removal of the prostheses, we can reconstruct the condyles by means of a large autologous bone graft, which we take from the midpart of the illiac bone. The fixation is done with a specially adapted plate rather than with screws. A few case examples with a longer follow-up are presented for whom the result was very gratifying. We also insist on the great importance of solid fixation of fractured condyles, particularly in cases of resection arthroplasty. Elbow arthrodeses should only be used where there is no chance of obtaining a sufficiently satisfactory result by means of an arthroplasty. In these rare cases, we have been using internal fixation with an adapted AO plate and the interposition of an autologous bone graft. In the future replantation of prostheses, possibly on neocondyles will become more important.

Arthrodesis↗
PubMed1987

[Anatomic variants of the muscles and tendons of the hand].

Among the patients undergoing surgery of the hand, the author found four cases in whom the tendon of extensor pollicis brevis twice did not arise from the muscle belly. In another case, the tendon of extensor pollicis brevis arose from the tendon of the abductor pollicis longus. In a fourth instance it was completely lacking. The question is raised to what degree these anomalies are associated with the great variation in the range of motion of the first metacarpophalangeal joint. In an additional case an extensor digitorum brevis was found as a surplus aberrant muscle. By contrast with these clinically silent findings is a young man with discomfort symptoms of the ulnaris nerve that made discover an abductor digiti minimi longus.

Adult↗
PubMed1986

Disuse osteoporosis in patients with total hip prostheses.

Aseptic loosening of total hip arthroplasty is still a serious problem. Bone quality might be one of the major factors influencing loosening. In a previous study, bone loss during the reparation phase was evaluated with modified computed tomography at the site of the implant. The present study documents the degree of disuse osteoporosis prior to and after surgery. Bone density of both tibiae of patients with unilateral artificial hip joints was evaluated longitudinally. Preoperatively a significant right-left difference was found, that has to be attributed to the preoperative unloading of the diseased leg. After surgery a slight but significant bone loss was found in both legs attributable to the immobilization following surgery and the reduced activity in the first 6 months. In successfully operated cases this loss is temporary. In one patient bone loss continued; after 1 year there are now clinical signs of implant loosening. Although the spectrum of physical activity in our group was wide, no correlation between activity and bone loss has been found so far.

Aged↗
PubMed1986

Clinical experience with total arthroplasty and hemiarthroplasty of the shoulder using the Neer prosthesis.

A consecutive series of 28 shoulders in 26 patients, treated since 1982 by either total arthroplasty (11 shoulders) or hemiarthroplasty (17 shoulders), are reviewed. A glenoid osteotomy was also performed in five of the shoulders with a hemiarthroplasty. Overall 16 shoulders were completely satisfactory with little pain and satisfactory movement. Nine had a total arthroplasty. The average range of shoulder elevation after total arthroplasty (121 degrees +/- 29 degrees) was significantly better than after hemiarthroplasty (91 degrees +/- 39 degrees). Pain was still present in seven shoulders with a hemiarthroplasty but in only one with a total joint replacement.

Adult↗
PubMed1986

Arthroplasty of the elbow. Experience with the Mark III GSB prosthesis.

Forty-five total elbow replacements using the Mark III GSB prosthesis are reviewed. Average follow-up was 2.7 years. The overall results were good in 87% of cases, fair in 9%, and poor in 4%. Excluding the two poor results, which required prosthesis removal, 96% of cases had no significant pain. The flexion/extension are improved 24 degrees and the supination/pronation arc improved 22 degrees. No prosthesis was loose and only one had a significant radiolucent line. The overall complication rate was 25%. Disassembling of the two components, due to inadequate ligament tension, was the most frequent complication and this occurred in four elbows.

Adult↗
PubMed1986

[The thumb saddle joint].

In the management of patients with osteoarthritis of the carpometacarpal joint of the thumb, good to very good results can be achieved both subjectively and objectively by surgical intervention. In young patients who do manual hard work and have isolated post-traumatic osteoarthritis of the trapeziometacarpal joint, the treatment method of choice is still arthrodesis. However, in women with postclimacteric osteoarthritis, which is very frequent, we prefer arthroplasty. Resection of the trapezium is a technique only used in selected cases, as it results in considerable loss of stability and strength. We prefer Silastic interposition arthroplasty to cemented total replacement. In patients with major involvement of the joints at the trapezium (especially where it connects with the scaphoid), the treatment of choice is implantation of a Swanson trapezium prosthesis, accompanied by surgical stabilization of the soft tissue. The good results we have achieved with this method, as reported in this paper, also justify its application in the future. In patients with isolated osteoarthritis of the carpometacarpal joint of the thumb we shall use the modified Swanson prosthesis more frequently in the future.

Adult↗
PubMed1986

[Long-term results of endoprosthetic joint replacement and synovectomy].

The operations most frequently performed for chronic polyarthritis are synovectomy and artificial joint replacement. The radioisotope synovectomy has in general reduced the need for operative synovectomy. Multicenter studies of the late results of operative synovectomy (over 10 years after the operation) show a lasting improvement in pain, although radiographically the destructive changes that are seen 10 years after the operation are similar to the non-operated side. The synovectomy can therefore buy important time since re-operation, e.g. arthroplasty, is performed mainly on clinical grounds and not on the roentgenographic appearance. Operative synovectomy (Larsen 0-2) is indicated when the radioisotope synovectomy fails. It should be performed as soon as possible. Primary operative synovectomy is mainly advised when mechanical factors are predominant (tenosynovitis, large masses of fibrin in a joint etc.) and where a denervation effect is produced at the same time (e.g. in the wrist). The remainder of this report concerns the multiplicity of problems with the various wrist- and finger joint-arthroplasties. Cemented prostheses and those with a fixed axis have been shown in the world literature to have a high need for re-operation because of loosening and secondary deformities of the fingers. The silastic spacer is more adaptable but is not without problems. This is particularly seen with constitutional or cortisone-induced ligamentous laxity where bone resorption due to the piston effect and abrasion becomes evident together with sinking and often breakage of the prosthesis. The attempts made to prevent this are reported. The improvement in function from the MP-arthroplasty is very dependent upon the condition of the PIP-joints and the thumb. The significance of this with respect to the operative indication is discussed. Although the PIP-arthroplasty can initially have a good range of motion, a reduction after a number of years can be seen because of periprosthetic fibrosis. In general, when the operative indication is correctly made and with good postoperative management, arthroplasty can give good long-term results. The carpometacarpal joint of the thumb is relatively seldom involved in polyarthritis and the main indication for arthroplasty is osteoarthritis. The extent of trapezium resection and the various types of prostheses are discussed. The authors warn against treating a single joint in isolation without considering the other joints which work together with it in a functional chain.

Adolescent↗