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Biomedical subjects

N Gschwend

Publications and source records attributed to N Gschwend.

At least 73 records · Page 4Linked to original sources
PubMed1986

[Long-term results after the surgical treatment of saddle joint arthrosis with Swanson's silastic prosthesis].

The use of a silastic implant in resection arthroplasty of the carpometacarpal joint of the thumb allows the joint space to be preserved. With the Swanson type arthroplasty relief of pain, good function, as well as stability and improved pinch force can be obtained, avoiding the consequence of carpal instability by narrowing of the joint space associated with resection of the trapezium alone or in combination with tendon interposition arthroplasty. The two main problems associated with Swanson arthroplasty are prosthetic dislocation and longterm stability of the prosthesis itself. The joint surface of the prosthesis wears out asymmetrically, and mild to severe foreign body reactions can be seen in the carpal bones, mainly the scaphoid. Clinical and radiological results of a series of 77 operations in 65 patients from 1975-1981 are presented and discussed.

Adult↗
PubMed1986

[The child's foot in juvenile polyarthritis (cP)].

The foot, with particular involvement of the ankle joint and forefoot, is an early and frequent site of inflammatory changes in juvenile rheumatoid arthritis. According to the type of disease (sero+ or sero-, polyarticular or pauciarticular, HLAB-27 positive), there is a great variety of symptoms and also of prognoses. The involvement of growth cartilage is the cause of an additional deforming factor over and above the usually progressive process. Varus and cavovarus deformities with clawtoes occur most frequently. Owing to the thickness of the joint cartilage, there is mostly no severe functional deficiency; if there is it often occurs only some what late. On the other hand, extensive bony fusions belong to the characteristic picture of certain forms of juvenile rheumatoid arthritis. Since pain occurs only in the presence of severe deformities due to localized pressure, it is rather seldom that patients with juvenile rheumatoid arthritis come for surgical treatment of their feet. Therefore, it is all the more important to point out the justification of synovectomy in all of these cases, where swelling cannot be removed by conservative measures and in the presence of signs of progressive destruction. Correction of deformities can be achieved by surgery aiming at soft tissue release and osteotomy, partly avoiding arthrodesis. The latter serves to correct fixed deformities and those that disturb function at the end of the growth period.

Ankle Joint↗
PubMed1986

[Elbow joint].

The elbow joint is a key joint for positioning of the hand. Four operations have to be considered for the rheumatoid elbow: removal of rheumatoid nodules and bursectomy, resection of the radial head, synovectomy, and arthroplasty. Synovectomy and arthroplasty are carefully analyzed, both from the point of view of recent international literature as well as personal experience. Synovectomy of the elbow is highly effective even when performed relatively late (stage 3 according to Larsen-Dahle-Eek) insofar as pain relief and swelling are concerned. In long-term disease, deterioration as assessed by radiology can usually not be prevented, but clinical improvement may be the reason for the relatively rare indication for arthroplasty. According to recent literature, the results of elbow arthroplasty vary greatly. Fully constrained hinges should no longer be used, and no decision has been made so far on whether semiconstrained or nonconstrained surface replacement is preferred. We use the semiconstrained GSB Mark II prosthesis, which has provided results in nearly 50 cases that rank among the best reported from the point of view of pain relief, improvement of ROM, and low complication rate. Use of our so-called transtricipital approach to the elbow has proved particularly valuable, especially with regard to lack of extension and muscle strength.

Arthritis, Rheumatoid↗
PubMed1983

Sport after total hip arthroplasty.

Up to now, sporting activity after total hip arthroplasty has been limited or terminated completely because of the risk of failure. In the case of younger patients, it is desirable to know whether this attitude is justified. Consequently, an analysis has been made of 110 patients (all male, average age at the time of the operation 55 years, 42 bilateral). Sport was practised in 78 and 56% of the cases prior to an after the operation respectively. The patients with intense sporting activity were examined and the findings compared with those who did not participate in a sporting activity after the operation. The incidence of replacement due to loosening is surprisingly higher among the group of patients with no sporting activity (14.3% to 1.6%). In the light of these findings, there is no need to prohibit sport in these cases. To allow for a gradual resumption of sport, guidelines have been elaborated on the basis of present-day knowledge of quantitative and qualitative hip strain. The short load peaks appearing as the heel touches the ground on walking or running will be attenuated by means of a viscoelastic heel pad.

Biomechanical Phenomena↗
PubMed1983

Replacement arthroplasty of the knee joint: trends and treatment after failure.

Knee joint replacement has progressed considerably in the past 15 years, although the difficulties are greater than those of hip replacement. At first, only the constrained hinge joint and a limited variety of unconstrained joints were available. Severe deformities of diseased knees and ligamentous insufficiency forced great changes to be made in unconstrained prostheses to ensure greater stability and motion and less wear and loosening. Further changes have also been made in constrained hinge joints; this has resulted in a great proliferation of prostheses of all types. Fully constrained prostheses now have restricted indications. Poor results are greatest with the fully constrained hinge group (36%) and lowest with the semiconstrained group (13%). The unconstrained prosthesis gives results intermediate between the others. Infection rate is highest in constrained and lowest in unconstrained prostheses. The loosening rate is lowest in the semiconstrained and unconstrained types.

Biomechanical Phenomena↗
PubMed1983

General surgical principles in rheumatoid arthritis: priorities.

The treatment of rheumatoid arthritis depends on a team effort, and the medical team should be led by a rheumatologist. The condition is systemic and the treatment is conservative. Surgery is but an episode in the overall treatment. There should be a therapeutic plan with priorities determined by progression from general to specific considerations. To illustrate general principles the author likens rheumatoid arthritis to a house on fire. Specific problems in treating rheumatoid arthritis are the uncertain prognosis in individual cases and the time taken to establish the progressive nature of the changes or the degree of subjective difficulty that may force surgical measures. Patient motivation is important. This is determined by internal and external forces--personality, social, family and financial factors. The patient's goals and desires must be considered in the light of the possibilities and complications of operation as well as the prognosis when operation is not performed.

Arthritis, Rheumatoid↗
PubMed1982

Surgical rehabilitation.

There is hardly any other disorder where the possibility of replacing destroyed joints by artificial ones has transformed the functional outcome so decisively as in rheumatoid arthritis. The advances achieved in surgery may even be regarded as the most important result of any research on rheumatoid arthritis as published in recent years. Arthroplastics account for almost half of all interventions in our own statistics which cover almost 6000 operations on patients with this disease. Surgical synovectomies account for more than 40 per cent, and various other techniques are used in only 10 per cent of operations. Indications and contra-indications are discussed first in a more general way, and the need for close collaboration of family doctor, rheumatologist, orthopaedic surgeon and highly qualified therapeutic staff is emphasized. In the following sections the most rewarding methods used for rehabilitation of the upper limbs are described, including pre- and post-surgical management as well as the results to be expected. Subsequently our standard programme for the surgical rehabilitation of the affected joints of the lower limbs is presented. Special reference is made to a new technique for the fixation of the arthroplasty in cases of rheumatoid acetabular protrusion.

Adult↗