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A Plastipore (porous polyethylene) Total Ossicular Replacement Prosthesis gave an excellent initial hearing result which was maintained for 14 years. Hearing then began to deteriorate and revision surgery showed disintegration of the prosthesis and a defect in the stapes footplate. Histological examination confirmed previous findings in porous polyethylene with multinucleated foreign body giant cells and breakdown of the material.
Implantation of the expanded polytetrafluoroethylene (e-PTFE) implant to achieve correction of nasolabial folds or thinning lip has been fraught with complications in spite of patient acceptance since its introduction in 1997. The four most frequent postoperative complications are extrusion, movement, infection, and swelling. In examination of 86 insertions of the 3.2 mm tubular implants, these sequelae are generally manageable for the physician and patient. If the patient understands possible courses of healing, both physician and patient satisfaction may be achieved.
The undulation pump total artificial heart (UPTAH) was developed by using small-size continuous-flow displacement-type blood pumps (undulation pump). To clarify and improve the problems accompanied by the implantation in the chest, 14 animal experiments were performed on goats weighing 41.3-79.2 kg. The UPTAH could be implanted in the chest of all goats and was driven with a modulation pulsatile mode. The first problem was the atrial suction effect. This problem could be prevented to some extent by developing the soft disk and by improving atrial cuffs. An automatic detection and releasing of the atrial suction effect was also tried. The next problem was acute lung edema accompanied by the postural change of the animal. Development of the automatic control of left atrial pressure could prevent this problem. Small blood leakage from a pinpoint hole in the seal membrane was the next problem. Improvement of the manufacturing procedure of the membrane prevented this. With these improvements, a 10 day survival could be obtained with this unique implantable total artificial heart.
Seventy-two total shoulder arthroplasties performed using Neer II press-fit humeral components and followed for an average of 4.1 years (range, 2-7.8 years) were analyzed radiographically. A humeral component was considered radiographically at risk for clinical loosening when a radiolucent line > or =2 mm in width was present in > or =3 zones or tilt or subsidence was identified on sequential radiographs by 2 of 3 or 3 of 3 independent observers. Forty components (55.6%) were judged to be at risk. There were no identifiable characteristics associated with the development of an at-risk humeral component except longer average follow-up of the at-risk group (4.7 years vs 3.3 years, P =.001). Humeral components at risk had a higher rate of endosteal erosion (P =.04) and greater number of zones with sclerosis. Radiographic changes around Neer II uncemented humeral components are common. Data from this study can be used as 1 benchmark to compare with alternate methods of humeral component fixation.
Repair of a groin hernia is strongly influenced by prosthetic mesh implantation carried out in nearly 50 % of all operations. Recurrency rates, however, did not decrease by this policy. Many different materials are available. Due to bioinstability on the long-term and elevated infection rates PTFE is not suitable for inguinal hernia repair. Polyester also provides no long-term stability and induces a chronic foreign body reaction. Polypropylene initially leads to an acute inflammatory reaction and often ends in fibrosis. Both reactions are related to the weight of the used mesh. All materials may lead to specific complications. These include seroma formation, infection, migration of the prosthesis with arrosion of organs, damage of the vas deferens, development of recurrency by shrinkage of the fibers around the mesh, formation of adhesions in the preperitoneal position, and chronic inguinal pain. Therefore, meshes should be used only after individual estimation of risks and benefit. This includes the hernia classification, the number of previous operations and the possibility of a defect in collagen metabolism. The unknown long-term risks for the patient may be taken only in strong indications.
The goal of bone reconstruction in revision total knee arthroplasty is to provide a stable support for the implant and to re-establish the correct joint line. Therefore, a useful, therapy-based classification of the defects is necessary. According to Stockley et al. (1992), the defects are classified into contained and uncontained defects. Uncontained defects can be reconstructed using structural allografts or metal wedges. In contained defects, cancellous allograft can be used. For aseptic loosening of total knee arthroplasty, the defect classification according to Engh and Parks (1994) can be helpful because of its recommendations for reconstruction. In case of the more common first or second graded defects, reconstruction is performed using modular revision components or allografts. For the rare third graded defects, bulk allografts or modular tumour endoprostheses are recommended. On the basis of more than 150 revision total knee arthroplasties performed in our hospital the classification of bone defects and their clinical consequences are presented in this review.
AIM: It was the purpose of this study to determine the postoperative subsidence of a cementless hip revision stem in regard to the degree of metaphyseal onset, diaphyseal fit and a three-point contact of the stem in the femur. METHODS: Data of 50 revision total hip replacements using a cementless revision straight stem (PFM-R) could be investigated. The degree of subsidence was measured on pelvic X-rays 6 and 12 months postoperatively. The degree of metaphyseal onset, diaphyseal fit and a three-point contact of the stem in the femur was determined on the immediate postoperative X-rays. RESULTS: The amount of subsidence was strongly related to the degree of metaphyseal onset. With minor onset (up to 25 % of the possible) stems subsided 9.4 (6 months), respectively, 13.2 millimeters (12 months) in average within the investigation periods. If there was a large degree of metaphyseal onset (more than 75 % of the possible) the average subsidence was only 1.6 (6 months) or 0.9 millimeters, respectively (12 months). Neither the amount of diaphyseal fit nor the presence of three-point contact of the stem in the femur influenced the subsidence significantly. Conclusion The amount of the postoperative subsidence of stems in cementless revision total hip arthroplasty is predominantly influenced by the degree of the metaphyseal onset of the prosthesis.
In our program of bone-anchored hearing aids we experienced two rare complications: a child with a hearing aid fell on her head and got an intrusion of the bone-screw into the intracranial space with a fracture of tabula externa and interna. There were no further intracranial complications, no hematoma or infection. The screw was explanted immediately with oto-microsurgical instruments and diamond burrs. The site of the screw was covered with a local skin flap. There were no complications in wound healing and the child got a second implant on the other side. A patient got an infection of his bone fixation screw and we took out the external fixation but left in place the bone screw, which was obviously still well fixed and the adjacent bone was without signs of infection. There was good secondary wound healing with local and systemic antibiotics. With almost completely healed external wound the patient got an intracranial abscess, that needed neurosurgical drainage. After long-time antibiotic treatment the patient is well again.
BACKGROUND: Gold implants in reconstructive surgery of the middle ear have proved to work sufficiently: That applies to tympanic cavity conditions without signs of chronic inflammation as also to the bacterially infected middle ear. For some years titanium implants are also in the use and established as well. The biocompatibility of titanium, the clinical and the audiological results are satisfactory. When using gold-prostheses in stapes surgery however, the still unsolved problem of occasional deafness has to be considered. PATIENTS: The clinical and functional results of middle ear surgery were examined retrospectively. There was no preselection of patients. 53 patients underwent middle ear surgery with titanium prostheses, 42 patients with gold prostheses. RESULTS: Due to their material properties and due to their delicate shape titanium prostheses (PORP, TORP) can be inserted into the tympanic cavity more simply and with better fit. The audiological results of gold and titanium prostheses are comparable. The extruding rate of the gold prostheses is substantial, whereas the extruding rate of titanium is negligible. CONCLUSION: The functional results of both materials are comparable. Due to the high extruding rates of gold prostheses titanium is clearly superior.
BACKGROUND: The practical value of high-frequency ultrasound (transducer frequency of 20 MHz) for studying lacrimal plugs positioned into canaliculi was proved. MATERIALS AND METHODS: Twelve patients with twenty intracanalicular plugs and two punctum plugs were examined via high-frequency B-scan ultrasonography using 20 MHz transducer (model I3 Sacramento, USA). Detection and localisation of the intracanalicular plugs was made by a 20 MHz sector scanner. The ultrasound examinations were performed 1 - 24 month after the placement of lacrimal plugs. After patient's head positioning, the high-frequency ultrasound investigation was done via immersion fluid (2 % methylcellulose). RESULTS: All patients with dry eye treated by lacrimal plug implant showed echographic structure in the lacrimal canaliculus. In transversal echograms it was possible to image both canaliculi together when the lids were half-closed. Contrary to the normal state, it was not necessary to inject viscous fluid into the canaliculus. High-resolution ultrasound was able to differentiate the normal canaliculus from the findings after plug placement. The echograms can vary from one plug type to another. Highly reflective structures were found after the placement of silicone intracanalicular plugs, e. g. HERRICK-Plug. In contrast, the ultrasonic image taken through acrylic polymer intracanalicular plugs showed homogeneous small reflective inner structure, e. g. SMART-Plug. However, smooth and flat acoustic interface between acrylic polymer plug and the lacrimal canaliculus produced strong echoes. CONCLUSIONS: 20 MHz ultrasound seems to be well suited for the detection and localisation of intracanalicular plugs. By use of 20 MHz ultrasound scans it is possible to get high-quality images of the intracanalicular plug and around lacrimal canaliculus. Compared with UBM, the depth of penetration is much higher with negligible resolution. On the whole, we believe that 20 MHz ultrasound can become a useful tool for evaluating the placement of intracanalicular plugs after insertion.
BACKGROUND: The purpose of this study was to present the outcomes of intraocular lens exchange in patients with opacified hydrophilic acrylic intraocular lenses. PATIENTS AND METHODS: Fifteen patients, who underwent uncomplicated phacoemulsification and hydrophilic acrylic intraocular lens (model SC600-2) implantation with good visual recovery, were re-referred to our department 76 - 188 weeks post-surgery due to progressive visual loss resulting from opacification of the implant. Intraocular lens exchange followed. The method of lens exchange is described. The effect on the best corrected visual acuity and on their refraction, the operative and postoperative complications are reported. RESULTS: All 15 patients underwent intraocular lens exchange. Twelve patients (80 %) had improvement of their best corrected visual acuity, in two cases (13 %) the best corrected visual acuity did not change, and in one case (7 %) the best corrected visual acuity deteriorated, this being attributed to progression of her age-related macular degeneration. None of the patients developed zonular dehiscence; in one patient the exchange was complicated with posterior capsule rupture, and an anterior chamber intraocular lens was implanted. One patient required cutting of the haptics before removal of the opacified intraocular lens. The mean Snellen (decimal) visual acuity was 0.35 (range 0.1 to 0.6) before lens exchange and 0.49 (range 0.1 to 0.6) six weeks after; the difference was significant (P < 0.05). Excluding the patient with the deterioration of her age-related macular degeneration, mean visual acuity of the remaining fourteen patients after the intraocular lens exchange was even better (0.56). CONCLUSION: Exchange of opacified hydrophilic acrylic intraocular lenses seems to be the only currently available effective treatment, leading to improvement of visual acuity.
BACKGROUND: A small series of patients with traumatic amputation of fingers have undergone treatment with a new technique using endomedullar osseointegrated titanium implant device that magnetically holds the finger prosthesis. METHODS: A two-stage reconstruction procedure with endomedullar osseointegrated titanium implants was performed to attach a finger prosthesis to the proximal, middle and distal phalanx. The first stage included implantation of the titanium fixture into the medullary cavity canal of the phalanx. After a 2-month rest period to allow the fixture to firmly osseointegrate with the phalanx of the bone, a skin-penetrating titan-magnetic abutment was placed on top of the fixture, to which the prosthesis was firmly attached. RESULTS: Good stability could be achieved using an endomedullar osseointegrated prosthesis. Easy handling is possible with the magnetic connection between finger and prosthesis. In the clinical use were no complications observed. We observed no infections and no problems with the soft tissue. CONCLUSIONS: The combination of osseointegrated titanium implants and magnetics for finger prosthetics provides several advantages. Such as stable fixation of the prosthetic finger to the bone, restoration of some sensory feedback with better osseoperception as well as an excellent cosmetic result.
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Metal stents are a valuable treatment modality for patients with biliary obstruction. However, we present here two patients whose cases may serve as a warning about an unusual complication associated with these stents. We encountered this complication after endoscopic retrograde cholangiography for obstructed metal biliary stents. The first patient, an 87-year-old man with a benign biliary stricture, failed to regain consciousness after clearing of his stent using a Dormia basket and balloon catheter. Cerebral air embolism was diagnosed on cerebral computed tomography, and transesophageal echocardiography revealed a patent foramen ovale as a precipitating factor for paradoxical air embolism. He survived and was discharged with a residual hemiparesis. In the second patient, a 54-year-old man who had a history of a Billroth II operation and chronic pancreatitis and who had a portal cavernoma with biliary obstruction due to collateral veins, electromechanical dissociation complicated the balloon-catheter stent revision. Echocardiography performed during cardiopulmonary resuscitation showed major air embolism to the right heart. The patient died. These cases demonstrate that air may gain access to the venous system during therapeutic endoscopic procedures of this type. It is likely that the large diameter of metal stents and the potential for these stents to lacerate venous structures facilitate the entry of air into the venous circulation, an event which may have life-threatening consequences.
INTRODUCTION: For the surgical therapy of lagophthalmos rigid gold implants were used. There are a lot of studies using rigid gold implants with widely different complications. In the primary study the small amount of patients is often a problem. The aim of our study was to survey the postoperative results and complications after insertion of rigid gold implants and to statistically compare the results with a meta-analysis. MATERIAL AND METHODS: 38 publications on 1000 rigid gold implants were analyzed in the context of a meta-analysis of the postoperative results. RESULTS: Complete lid closure can be obtained in 84.5 % with the rigid gold implants. The postoperative complication rates were 13.4 % for bulging, 6.4 % for migration, 6.8 % for extrusion, 11.5 % for corneal astigmatism and 7.0 % postoperative infections. DISCUSSION: Lidloading is a very simple and reversible procedure for the surgical treatment of lagophthalmos. The statistical analysis in using rigid gold implants showed a significant rate of postoperative complications. To increase the effectivity of the treatment method these results should be taken into account for alternative implants.
After laryngectomy the majority of patients receive a vocal rehabilitation by tracheo-esophageal puncture and insertion of voice prosthesis. Periprosthetic leakage causing aspiration represents a well known complication and is frequently treated by temporary removal of the prosthesis with shrinkage of the shunt. Here we describe 10 patients with such a leakage treated by collagen injection for periprosthetic tissue augmentation. A mean of 1,6 injections were necessary for complete control of the leakage. The injection was well tolerated and was found effective for median period of 9,3 months. In our hands the periprosthetic collagen injection represents an effective and well tolerated procedure for temporary augmentation of tracheo-esophageal leakage in post-laryngectomy patients. However, alternative fillers without pre-testing necessity and longer augmentation intervals should be considered.
BACKGROUND: There is a reported 1% incidence of delayed migration of extrusions of the electrode arrays out of the cochlea. METHODS: A titanium clip to fix the electrode array of the MED EL Combi 40 Cochlear Implant System is described. The clip is designed and shaped in a double U configuration. The clip material allows easy adaption to the individual anatomical situation. The clip is fixed to a bony bridge at the incus bar and fixes the electrode in a plane parallel to the chorda facial angle. It is closed around the electrode similarly to a stapes piston around the incus. Additional tests which examined the possible risk of damaging the electrode carrier and clinical findings are described. RESULTS: The clip was used in 23 cases with a follow-up period up to 1 year. No signs for dislocation of the electrode were found. In one revision case the clip was covered with a thin mucosal layer. The electrode array showed no signs of damage. Intraoperative findings confirmed the experimental tests on the electrode fixation. CONCLUSION: The titanium clip facilitates safe and quick fixation of the electrode array and prevents dislocation. its flexibility and shape minimizes the risk of damage.
PROBLEM: In revision alloarthroplasty the need for bone allografts increased. The documentation of the defects is not done routinely. METHOD: For better documentation the German Society for Orthopedics and Traumatology (DGOT) developed a new and practical defect classification system. It was tested clinically in the last 6 years. RESULTS: In the acetabulum and femoral shaft seven defect types were distinguished and presented in figures. For the acetabulum: 1 cavitary holes, 2-4 unisegmental, 5 bisegmental, 6 trisegmental, 7 pelvic instability. For the femur: 1 intramedullary 2 trochanter 3 calcar 4 med. shaft 5 lat. shaft 6 part. diaphysis 7 total diaphysis. CONCLUSION: With this classification system we could better compared different reconstruction approaches in endoprosthetic surgery.