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PubMedDate not supplied

[Basic design concepts for the removable partial prosthesis and its social aspects. II. The prosthesis on attachments].

The subject of prostheses on attachments is discussed with particular reference to the biomechanical aspects of tooth-borne dentures and extension-base-dentures. Commercial attachments can be classed as precision attachments and stress-breakers. The indications for the employment of each kind in accordance with individual situations and the degree of edentation are explained. The resort to attachments is, in any event, a compromise solution undertaken primarily for cosmetic reasons. Some types of attachments directly created in the laboratory, or controlled load distribution prostheses employing wired, enable a more personal solution to be elaborated to suit the needs of a given case.

Biomechanical Phenomena↗
PubMed2001

Penile prosthesis in the organ transplant recipient.

OBJECTIVES: To determine whether pelvic organ transplant recipients are at a higher risk of developing complications after placement of a penile prosthesis relative to those receiving a penile prosthesis who did not undergo pelvic organ transplantation. METHODS: Two hundred eleven men underwent placement of a penile prosthesis by a single urologist at our institution between July 1994 and March 2000. Of these, 46 patients had undergone pelvic organ transplantation before placement of the penile prosthesis. The average time from transplantation was 43 months. The average follow-up after prosthesis placement was 23 months. These patients were monitored for various complications, including infection, malfunction, autoinflation, and injury to the prosthesis. They were compared with a cohort of men who had had a prosthesis placed but had not received pelvic organ transplantation. RESULTS: The overall complication rate was significantly higher in the transplant patients (22%) than in the nontransplant patients (7.9%) receiving prostheses (P <0.01). Infection was seen in 2 transplant patients (4.3%) and in 7 nontransplant patients (4.2%) (P <1). Malfunction occurred in 4 of the transplant patients (8.7%) and 6 of the nontransplant patients (3.6%) (P <0.2). In those patients with a prosthesis malfunction, 9 of 10 involved a three-piece prosthesis. All four malfunctions in the transplant group occurred in three-piece prostheses. The difference in the rate of malfunction was statistically significant (P <0.001) when comparing the three-piece prosthesis in the transplant and nontransplant patients (P <0.001). Surgical injury to the retroperitoneal reservoir occurred in 4 transplant patients (8.7%) (all with three-piece prostheses) and in none of the nontransplant patients (P <0.001). CONCLUSIONS: The risk of infection after insertion of penile prostheses in patients with pelvic organ transplantation was similar to that in nontransplant patients. The risk of malfunction and injury to the prosthesis (three-piece) was higher in transplant patients. The overall complication rate was significantly higher in patients after transplantation and can be attributed to the reservoir complications related to three-piece prostheses. In patients with a prosthesis that did not have a retroperitoneal reservoir, no significant difference in the overall complication rate was observed. Pelvic organ transplant recipients in whom traditional conservative therapy for erectile dysfunction fails should be considered candidates for penile prosthesis placement. However, three-piece prostheses should be avoided, as these patients are best served with prostheses that do not require a retroperitoneal reservoir.

Adult↗
PubMed2005

Antibiotic coating reduces penile prosthesis infection.

AIM: To evaluate the efficacy of a new antibiotic-coated (rifampicin+monocycline) penile prosthesis in prevention of bacterial adhesion and reduction of penile prosthesis infection. METHODS: In a retrospective analysis of medical records of men who had undergone implantation of American Medical Systems (AMS) inflatable penile prostheses between July 1990 and November 2003, we compared patients with AMS antibiotic-coated prostheses and patients with AMS nonantibiotic-coated prostheses. A total of 152 men aged from 27 to 79 years with erectile dysfunction underwent implantation of the AMS inflatable penile prosthesis. Fifty-eight patients received the antibiotic-coated prosthesis between July 2001 and November 2003, and 94 patients received the nonantibiotic-coated prosthesis between July 1990 and June 2001. RESULTS: In most cases infection was present; it was detected 1-2 days or up to 3-6 months after implantation. Complications including infection, which required surgical intervention, were observed in 15 patients of the nonantibiotic-coated prosthesis group (three reoperations for infection), and noninfection-related failure in five patients of the antibiotic-coated prosthesis group. In the nonantibiotic-coated prosthesis group of patients, time to infection ranged from 1 day to 6 months (mean 3.5 months). The antibiotic-coated prosthesis group of patients immediately after surgery and during the short- and intermediate-term follow-up had no infection of the penile prosthesis. CONCLUSIONS: We suggest that the antibiotic locally delivered from the prosthesis coating might be an effective supplement for prevention of prosthesis-related infection in penile prosthesis surgery.

Adult↗
PubMed2003

Predictors of prosthesis survival, growth, and functional status following mechanical mitral valve replacement in children aged <5 years, a multi-institutional study.

BACKGROUND: Prosthesis survival, growth, and functional status after initial mechanical mitral valve replacement (MVR) in children <5 years of age are poorly defined. METHODS AND RESULTS: The experience of the Pediatric Cardiac Care Consortium (45 centers, 1982 to 1999), which included 102 survivors after initial MVR, was analyzed. Median follow-up: 6.0 years (interquartile range: 3.0 to 10.6 years; 96% complete). Twenty-nine survivors had undergone a second MVR at an interval of 4.8+/-3.8 years after initial MVR. Reasons for second MVR were prosthetic valve stenosis 24 (83%), thrombosis 4 (14%), and endocarditis 1 (3%). For those who had second MVR, prosthesis sizes were: first MVR 19+/-2 mm and second MVR 22+/-3 mm, and their body weight increased from 7.4+/-2.8 kg to 16.8+/-10.5 kg. To identify risk factors for having a second MVR, the 29 second MVR survivors were compared with the 73 who did not have a second MVR on first-MVR demographic and perioperative variables. By univariate analysis, patients with shorter prosthesis survival were younger, weighed less, had smaller prostheses, greater ratio of prosthesis size:body weight, were less likely to have a St. Jude prosthesis and more likely to have Shone's syndrome. By multivariate analysis prosthesis survival was predicted only by first MVR age: odds ratio (OR) 7.7 (95% confidence interval [CI] 2.6-22.7) and prosthesis size: OR 6.8 (95% CI 2.6-18.2). High risk patients (age <2 years and prosthesis <20 mm at first MVR) had an OR=46.3 compared with low-risk patients (age >or=2 years and prosthesis >or=20 mm at first MVR) over similar follow-up intervals. Using first-MVR weight-matched controls, body weight increased similarly for patients <2 years old who had a second MVR versus those who did not. Prosthesis size, however, differed significantly, with second MVR patients having smaller prostheses at first MVR (18.7+/-0.8 mm versus 22.4+/-3.6 mm, P=0.017). An estimate of current New York Heart Association (NYHA) functional status was class 1 in 76%, class 2 in 22%, and classes 3 or 4 in 2%. CONCLUSIONS: Prosthesis survival can be predicted based on first MVR age and prosthesis size. Somatic growth is comparable regardless of the need for second MVR. There is an increment in prosthesis size at second MVR, suggesting continued annular growth. Significant limitation of function after MVR is uncommon. MVR may be an appropriate strategy for children <5 years old despite the risk of second MVR in the youngest patients in whom the smallest prostheses are used.

Age Distribution↗
PubMed2006

[Clinical use of a voice prosthesis with a flap valve containing silver oxide (Blom-Singer Advantage), biofilm formation, in-situ lifetime and indication].

BACKGROUND: Fungal growth and the resulting leakage through an indwelling voice prosthesis remains the most frequent reason of prosthesis failure and renewal. In some patients leakage caused by fungal growth occurs in very short intervals (below 12 weeks in-situ lifetime) and causes frequent treatments and high costs. METHODS: The Blom-Singer(R) Advantage voice prosthesis is a new prosthesis type with a modified flange design, a flap valve containing 7 % silver oxide in the silicon matrix and is expected to be resistant against biofilm formation and fungal growth. PATIENTS: In a clinical trial we used the Blom-Singer(R) Advantage prosthesis in 33 patients with short in-situ lifetimes of their voice prosthesis and analysed the effects on in-situ lifetime and complications statistically. RESULTS: The clinical use of the Blom-Singer(R) Advantage prosthesis was similar to other types of indwelling voice prosthesis (Provox(R) II, Blom-Singer Indwelling(R)) and did not cause any special problems. Prosthesis specific side effects (i. e. allergy against silver oxide) did not occur. Statistical analysis of the aquired data showed an interindividually changing, but significantly longer in-situ lifetime for the Blom-Singer(R) Advantage prosthesis. The mean device lifetime increased from 36 days (median 36 days) to a mean lifetime of 110 days (median 87 days) with the use of the Blom-Singer(R) Advantage prosthesis. CONCLUSIONS: Using a voice prosthesis with a valve containing silver oxide can normalize and even increase the in-situ lifetime in patients with frequent changing procedures caused by fungal growth on the valve. Therefore we recommend the use of this type of voice prosthesis for those patients as reduction of costs and effort results.

Aged↗
PubMed2000

Structural response and relative strength of a laminated composite hip prosthesis: effects of functional activity.

To obtain a better appreciation for the structural performance of a laminated composite hip prosthesis (CP), we examined in situ prosthesis structural response and relative strengths as a function of walking and stair climbing using our previously developed analysis guidelines. Accordingly, we examined overall prosthesis structural response utilizing a global continuum level modeling approach and prosthesis relative strengths using a local microstructural (or ply-level) modeling approach. As a reference and control, we examined the structural performance of the intact natural femur (NAT) and a titanium alloy (Ti) based hip prosthesis. In terms of the overall structural response, i.e., the femur/prosthesis deformational response, stem/bone interfacial stress transfer, and calcar strain energy density restored, the performance of the CP prosthesis was moderately improved over that of the control Ti prosthesis and better approximates the NAT response. In terms of relative strength, we found that the neck of the CP prosthesis failed for all activities with the exception of the mid-stance phase of level walking. However, the prosthesis appears to have sufficient relative strength for function at positions distal to the neck of the prosthesis. While these results dampen enthusiasm for consideration of laminated composite hip prostheses designed with a shape based on a metal alloy implant, they indirectly support consideration of alternate hip prosthesis structural designs such as using a better supported prosthesis neck or utilizing metal/composite hybrid constructions. Importantly, our simulation and analysis approach could be utilized in the design of other laminated composite biomedical structural components.

Alloys↗
PubMed2004

[Reconstruction of mandibular defect by using Titanium mandibular prosthesis: a preliminary experimental study].

PURPOSE: The aim of this experiment was to investigate the possibility of application of mandibular reconstruction with titanium mandibular prosthesis. METHODS: Two healthy adult goats were used in this study. Spiral CT of the mandibular region was performed. The data collected was related to the computer. Then a 5 cm mandibular body defect and a mandibular angle defect were designed accordingly. Titanium mandibular prostheses were manufactured according to the size of the above defect. Surgical operation was performed and the prosthesis were implanted into the aimed defects and internal fixation was used. Autogenic bone graft was introduced into the holes of the angle prosthesis. Radiographic examination was used to evaluate the healing of prostheses every month after operation. Three months later, the animal was sacrificed and the mandible specimens were sectioned for histological and biomechanical evaluation. RESULTS: One of the body prosthesis was found to be exposed two weeks after operation. Four weeks later, fixation failed and the anterior part of the prosthesis separated from the mandible attached. The other body prosthesis also suffered from exposure,but the connection between the prosthesis and the mandible was still stable. Histological examination revealed that there was presence of osseointegration in the angle prosthesis as well as area that was not exposed in the body prosthesis model. Reattachment of the muscles to the bone graft area was found. CONCLUSIONS: CAD/CAM generated Titanium mandibular prosthesis is applicable in human model. The vitality of this experiment revealed that a tight closure plays an important role in the healing by osseointegration. If there was any exposure, the osseointegration will be failed. Reattachment of the muscle to the prosthesis can be achieved by "muscle-bone-prosthesis"model.

Animals↗
PubMed1989

[Peri-prosthesis fractures in total hip endoprostheses].

Periprosthetic fractures after total hip arthroplasty (THA) were found in 0.77% (33 fractures in 4280 THA). At the time of fracture the prosthesis was loose in about one-third of the cases. In most cases (63%), the fracture was located at the distal end of the prosthesis. Fractures at this location were transverse or short oblique; those situated more distally were spiral. Whereas those located along the prosthesis shaft were long oblique. Open reduction internal fixation was performed immediately for all fractures. Thirty patients were followed an average of 2.7 years (1 year-11 years) after fracture. In 28 cases stabilization was obtained using a plate. In 2 cases the prosthesis was changed at the same time as plate stabilization. 1 case the lossened prosthesis was converted to a Girdlestone. A primary change in the prosthesis without osteosynthesis was performed in 2 cases. One year after operation all fractures were healed. We recommend a large DC plate for fractures distal to the tip of the prosthesis (spiral fractures). In cases of stable THA, we stabilized the fracture at the level of the tip of the prosthesis or along the shaft of the prosthesis itself, using a wave plate with corticocancellous bone graft. Fractures along the loosened prosthesis but with good bone stock are treated by implantation of a long-stem prosthesis. If bone stock is poor, we recommend the fracture be stabilized using a plate. Only after the fracture is healed do we revise the prosthesis.

Aged↗
PubMed1997

Aerodynamic characteristics of the Nijdam voice prosthesis in relation to tracheo-esophageal wall thickness.

Tracheo-esophageal speech using various prostheses is currently the most successful form of voice and speech rehabilitation for laryngectomies. Main inter-device differences are durability and trans-device pressure loss during speech. The valveless indwelling Nijdam voice prosthesis is a new voice prosthesis. A barrier mechanism is created by a combination of the esophageal mucosa and the umbrella-like "hat" of the prosthesis that covers the esophageal side of the tracheo-esophageal fistula. The Nijdam prosthesis can be used clinically for longer periods of time when compared to such other indwelling voice prostheses as the Provox prosthesis and the low-resistance Groningen prosthesis. However, transdevice pressure loss during speech has been unknown. Adjustment of the shft length of the Nijdam voice prosthesis to tracheo-esophageal wall thickness was expected to affect trans-device pressure loss during speech. We report the results of in vitro tests to quantify the effect of tracheo-esophageal wall thickness on trans-device pressure loss. In the present study pressure loss was measured at different air flow rates in relation to tracheo-esophageal wall thickness. Findings demonstrated that when shaft length of the Nijdam prosthesis corresponded exactly to tracheo-esophageal wall thickness, trans-device pressure loss was comparable to that of the Provox prosthesis. If a relatively shorter Nijdam prosthesis was chosen to prevent aspiration from occurring, the pressure loss across the prosthesis increased to that of the low-resistance Groningen prosthesis.

Esophagus↗