[Ambulatory surgery in orthopedics--nothing new!].
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Ambulatory Surgical Procedures↗
Biomedical subjects
R Gradinger
Publications and source records attributed to R Gradinger.
Influence of various irrigation fluids on articular cartilage.
When bovine articular cartilage was incubated in Ringer's solution, considerable amounts of proteoglycan were washed out of the cartilage. Thus, 4% of the proteoglycan was lost into the medium during an incubation of 4 hours. Subsequently, it was found that ionic aqueous media like saline or Ringer's solution extracted much more proteoglycan than ion-free media like distilled water or a variety of carbohydrate containing solutions. In separate experiments, it could be shown that solutions of 20% sorbitol and 2% mannitol exhibited particularly low proteoglycan extracting properties. It was found that the extraction of proteoglycan was dependent on the ion concentration in the aqueous media. The extraction of proteoglycan by sodium chloride was negligible at NaCl concentrations of 0.1% and lower. Proteoglycan loss from cartilage was only induced at 0.9% NaCl. Using intact rat femoral heads it could be shown that the elution of proteoglycan from cartilage occurred as well when the cartilage was intact. Here, the elution occurred at a slower rate but the differences between ionic and ion-free solutions were greater. By electronmicroscopic examination of bovine cartilage incubated in different media, it was observed that Ringer's solution induced a more uneven and rougher appearance of the cartilage surface than did 10% mannitol solution, indicating that probably a denudation of collagen fibers occurs on the loss of proteoglycan from the cartilage. Because the observed proteoglycan washout occurred within rather short periods of contact of the cartilage with the medium, it is concluded that this may be of relevance for the clinical situation during arthroscopic procedures. The use of preferably isotonic carbohydrate solutions like 5% mannitol is suggested to prevent unnecessary loss of proteoglycan from hyaline cartilage.
Animals↗
Custom made total knee-replacement in patients with primary and secondary bone tumors.
The authors present an account of a group of 51 patients to whom an individual endoprosthesis of the knee joint was implanted on account of a tumour. A primary bone tumour was involved in 42 cases and a metastatic process in 9 cases. Twenty-four endoprostheses were cemented, 26 were implanted without cement. The mean follow-up period was 43 months. Functional results excellent and good in 61%, poor results only in 5%.
Adolescent↗
[Current status of cementless hip endoprostheses ].
In young patients, the results of cemented hip joint replacement are less than satisfactory on account of the high rate of aseptic loosening involving in particular the acetabular component. With the aid of suitable uncemented prostheses and a meticulous surgical technique, the results obtained in this group can be improved. On an interim basis, an uncemented acetabular component may be combined with a cemented femoral component. The problem of wear and foreign body-induced bone resorption remains unsolved. New materials will possibly rectify this problem. Customized prostheses have opened up new possibilities, in particular for the severely deformed hip joint, but whether they will improve the results of standard replacements has yet to be shown. Before introducing a new prosthesis, thorough use should be made of the testing possibilities available. In the elderly patient with a reduced life expectancy, the cemented prostheses continue to be the method of first choice, since it permits immediate pain-free weight-bearing.
Adult↗
[Special endoprostheses of the knee joint in bone tumors].
Since the introduction of more effective adjuvant therapies in the area of primary and secondary bone tumors, limb salvage procedures have become more and more important. At the Orthopedic Department of the Technical University, Munich, 52 special knee prostheses have been implanted in patients with malignant tumors of the distal femur and proximal tibia. On the basis of the ISOLS criteria, the functional results achieved were excellent in 14%, good in 47%, satisfactory in 35%, and poor in only 5% of patients after an average follow-up period of 43 months (range: 3-156 months). The perioperative complication rate was 27%, and late complications were material fatigue and wear. In the case of primary tumors, a customized prostheses, and in the case of secondary tumors a modular system is recommended. Individual treatment planning is essential.
Bone Neoplasms↗
[Partial endoprosthetic reconstruction of the pelvis in malignant tumors].
Twenty-five patients underwent an internal hemipelvectomy with endoprosthetic reconstruction of the pelvis for primary bone tumor (n = 17) or bone metastasis in the pelvis (n = 8). According to the Enneking tumor classification system, there were 9 stage II B tumors and 16 stage III. Conventional metal or polyacetal prostheses were used in 5 cases, and in 20 anatomically adaptable modular prostheses with intramedullary anchorage were implanted. In the last 11 cases a 3D CT-controlled manufactured model of the pelvis was used. The functional results according to Enneking were good in 5 cases, fair in 11, and poor in 7. The last endoprosthetic system showed better results, because it is easier to implant and the possibility failure is reduced. The learning curve of the surgeon is important, too.
Adolescent↗
[MRI as decisive diagnostic procedure in Perthes disease. Early diagnosis of femoral head necrosis in childhood].
PROBLEM: In order to achieve better final results in Perthes disease, the diagnosis should be established as early and as accurately as possible. This is rarely achieved with conventional X-ray procedures. OWN EXPERIENCE: Since 1986, a total of 50 children with Perthes disease were submitted to MRI follow-up examinations employing T1 and T2-weighted coronary an sagittal sections and the results compared with the findings of conventional X-ray examinations. RESULTS: The authors developed their own MRI staging and typing scheme on the basis of the MRI extent of the necrosis. Catterall's group classification could not be translated to the MRI since the latter usually showed more extensive necrosis. Agreement was found only in group I. With the aid of MR imaging, it proved possible to diagnose a case of Perthes disease earlier, the total extent of the necrosis was established earlier, and also the final form of the epiphysis after completion of re-modelling was already predictable in stage II. The indication for treatment and intra-trochanteric osteotomy was established on the basis of the MR image. Further invasive investigations were not needed. CONCLUSIONS: In the case of Perthes disease, MRI should be given preference over other diagnostic procedures and, despite the greater expenditure of time and greater cost, should be routinely employed in this disease.
Child↗
[Structures of the knee joint in nuclear magnetic resonance tomography. Improved representation with 3D volume imaging].
Despite 3D gradient echo technique has a better spacial resolution than spin echo sequences, 3D imaging is not well accepted for clinical routine. Because of the large amount of data evaluation cannot be done by single photo-documented slices. Postprocessing of the 3D data sets with an image analysis system is indispensable. A maximum of two different gradient echo sequences (FLASH, FISP) are necessary for imaging of the whole interesting volume with continuous slices. Time of examination is shorter (16 resp. 32 minutes) compared with conventional spin echo sequences. In our opinion 3D gradient echo-sequences are a reliable noninvasive technique for the evaluation of pathological changes of the knee joint which could replace diagnostic arthroscopy in the future.
Bone Neoplasms↗
Osteoblastoma of the coccyx. A report of two cases.
Osteoblastoma, defined as a benign bone tumor by Jaffe and Lichtenstein, together with osteoid osteoma and multifocal osteoblastoma, belongs to the osteoblastic tumors. Due to the variable features of this tumor, differential diagnosis comprises fibrous dysplasia, giant cell tumor, aneurysmal bone cyst and osteoid osteoma; histological analysis is the only way to obtain a definite answer about the tumor type. Occasionally differential diagnosis from aggressive osteoblastoma and osteosarcoma may be difficult. The history of symptoms is usually long and diagnosis may be difficult both clinically and histologically.
Adult↗
Cementless prosthesis of the hip joint with "spongy metal" surface. A prospective study.
Our investigations in human specimens and animal experiments show that prostheses with a spongy metal surface can become fixed by bony ingrowth to varying degrees. After consistent clinical and radiological follow-up over 12-65 months (mean 34 months) in a prospective study of 100 consecutive patients in whom 106 cementless total hip replacements had been carried out, we were able to show that after 1 year 82% of patients were pain-free with the prosthesis fixed by bony ingrowth, 8% were pain-free with the prosthesis fixed by dense fibrous tissue and 10% were not pain-free, but did not want revision surgery. Thigh pain decreased steadily from 53% 3 months postoperatively to 6.6% 15 months after operation. We believe that, when the implantation technique is exact, a high percentage of cementless spongy metal prostheses are fixed by bony ingrowth, and that a cementless prosthesis should be implanted only in patients under 60 years of age without osteoporosis.
Female↗
[The diagnostic accuracy of MRT in cruciate ligament injuries].
Lesions of the anterior cruciate ligaments may be demonstrated by MRI with an accuracy of 99%. Standardised technique with sagittal and coronal projections produces excellent results. Localisation of the site of rupture can be achieved in 95% of cases. MRI provides a valuable method for diagnosing lesions of the cruciate ligaments.
Adolescent↗
[Magnetic resonance tomography in the assessment of anterior cruciate ligament reconstruction by tendon grafts].
150 patients were examined via magnetic resonance (MR) after anterior cruciate (ACL) ligament reconstruction (76 patellar tendon grafts, 53 semitendinous tendon grafts and 21 sutures). The results of MR were compared with clinical tests (Lachman, pivot-shift and anterior drawer test), in 2 cases with the operative findings, and in one case with arthroscopy findings. In 91% of patients with a clinically stable knee we found a continuous low-intensity ligamental structure. 10 patients were examined twice or more between 8 days and 6 months after surgery. Ligamental structures of low signal intensity did not significantly change their MR characteristics. MR is a valuable noninvasive method for evaluating ligament reconstructions.
Adult↗
Pelvic osteosarcoma. Resection, reconstruction, local control, and survival statistics.
Nine patients with a malignant tumor in the periacetabular region of the pelvis were treated with a Type IIC resection and were reconstructed using a cementless, adaptable prosthetic system. In two patients, a new planning strategy was applied using three-dimensional reconstruction. There were two chondrosarcomas, three Ewing-sarcomas, two osteosarcomas, and two metastases of thyroid cancer. Excision was wide, marginal, and intralesional in three cases each. Ages ranged from eight to 68 years (average, 40 years), and follow-up periods ranged from 12 to 36 months with an average of 27 months. Overall functional evaluation was good in five cases, fair in three, and poor in one. Four patients died of local recurrences and lung metastases; all of them had marginal or intralesional resections. Histologic analysis of one retrieved specimen revealed bone ingrowth with connective tissue interface. Three-dimensional planning has proven to be a very valuable tool for achieving an anatomic reconstruction of the pelvic ring. These results are encouraging and endorse the authors to continue with the current approach of prosthetic reconstruction following Type IIC resections.
Acetabulum↗
[X-ray diagnosis of the spine].
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Fractures, Bone↗
[Medical advice for golfers].
Although golf is an ideal form of exercise for all age groups, complete mastery of the specific movements involved is a prerequisite. The typical golfing injuries and and pathological sequelae are usually the results of faulty driving and hitting techniques. Apart from golfer's shoulder and golfer's elbow, complaints affecting the lumber spine predominate.
Golf↗
[Backache--causes, diagnosis and therapy].
Low back pain is considered to be a symptom of a variety of changes and disorders affecting the lumbar spine, the sacrococcyx and pelvis, but it may also be a symptom of disorders affecting the neighboring organs. If these points are taken into account and an accurate diagnostic evaluation including such modern procedures as scintigraphy, CT and MR imaging, low back pain can now--in contrast to 50 years ago--be analysed, and often treated with considerable success. In many cases, conservative treatment proves possible. In the presence of relevant morphological findings, however, various surgical procedures, developed in particular in recent years, offer new possibilities.
Back Pain↗
[Surgical therapy of backache].
Apart from disc prolapse, there is a range of other disorders associated with low back pain, for which, when all conservative efforts have failed, surgical treatment should be offered. It must be emphasized, however, that the indication for surgery needs to be rigorously applied, since the most common cause of failure of surgical therapy is an erroneous surgical indication. Here, the clarification of the cause of the pain and not the diagnosis per se is decisive. In particular in degenerative disorders of the lumbar spine in the elderly, the diagnoses established often have little pathological value. Unfortunately, in many cases the real cause of low back pain still cannot be clarified with certainty. Our experience to date, however, in particular with the use of modern implants, shows that, in cases of lumbar spinal stenosis especially, tumors and pronounced segmental instability, excellent results can be achieved with surgery.
Back Pain↗
[Capsular ligament injuries of the knee joint. Significance of anamnesis and findings].
Despite the enormous developments in imaging procedures, the patient's history and clinical examination remain the basis for the diagnosis of fresh injuries to the knee. The description of the mechanisms of the accident as revealed by the case history already provides important clues. The clinical examination must cover all the anatomical detection of lesions of individual parts of the capsular ligaments. With an appropriate knowledge of anatomy, and adequate experience in performing the examination, the general physician (with no specialized orthopedic knowledge) can obtain a good idea of the nature and severity of the injury.
Arthroscopy↗