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[Intracondylar knee joint prosthesis with rotation capacity- Endo model].

The St. Georg total knee prosthesis has been modified to incorporate axial rotation of the tibial component. The kinematics approximate more those of the normal knee and the stress imposed at the bone-cement interface are attenuated, thus reducing the risk of mechanical failure. The construction and laboratory testing are described.

Biomechanical Phenomena↗

[A concept of need and construction of a hip joint prosthesis with isolation of the friction point from the tissue].

The paper presents data available in the literature and the author's own data on the causes of bone tissue resolution around endoprostheses and on the occurrence of their aseptic instability. The author's own clinical data on 546 operations and follow-ups up to 16 years are strong evidence and his experimental findings are unique in the number of animals operated on and follow-up periods. The material was examined roentgenologically, morphologically, spectroscopically and the mineral content of bone tissue microstructures were determined. With the methods applied, the author clearly shows the role of tissue metallosis in the occurrence of aseptic instability of prosthesis. The author presents two up-to-day constructions of the total-type endoprostheses with the friction point isolated from tissue. The prostheses are accessible for manufacture at the modern enterprises and require no materials in short supply.

Animals↗

Bacterial joint infections in England and Wales: analysis of bacterial isolates over a four year period.

Data from 1158 cases of septic arthritis reported to the Public Health Laboratory Service (PHLS) Communicable Disease Control Centre (CDSC) from England and Wales over a 4 yr period (January 1990 December 1993) are presented. Reports where a bacterial organism was isolated from synovial fluid, or where an organism was isolated from blood cultures where a diagnosis of septic arthritis was reported, were examined. Reports of infection were more common in children (12.7% of infections were in the under 10 age group) and the elderly (54.7% aged 60 or over), and were higher in males in all age groups except in the elderly. The most common causative organisms remain staphylococcal and streptococcal species, comprising 40.6% (470) and 28% (324) of cases, respectively. The most common streptococci seen were Streptococcus pneumoniae and Lancefield group A beta-haemolytic Streptococcus organisms, 60.8% (197/324), although group B, C and G organisms accounted for 33.6% of streptococcal isolates (109/324). Haemophilus influenzae septic arthritis is not exclusive to children as 23.2% (16-69) of cases occurred over the age of 15. A total of 48% (635) of isolates were identified from both synovial fluid and blood cultures, 32.6% (378) from joint fluid alone and 12.5% (146) from blood cultures. Although this study excludes cases of septic arthritis where no organism was isolated, it presents important bacteriological information from a large number of isolates from England and Wales over a 4 yr period. Risk factors identified include a joint prosthesis, joint disease/connective tissue disorder. immunosuppression and diabetes.

Adolescent↗

[The Roseland prosthesis].

Total joint replacement of the trapezio-metacarpal (TMC) joint is one of the procedures available for the surgical treatment of degenerative osteoarthritis or rheumatoid arthritis of the first carpometacarpal joint. A four French Alpine surgeon group, (C. Lebrun, P. Massart, F. Moutet and C. Sartorius) have developed a new cementless total TMC joint prosthesis: the Roseland prosthesis. Such a device tries to improve the biomechanical conditions of the La Caffinière's implant, which was introduced in 1973. Clinical data of a 24 patients with a 38 month mean follow-up series are reported.

Adult↗

[Prosthesis replacement in the hip joint in prosthesis fracture. Clinical and radiological results after 5 years].

The results of 45 revisions performed for fracture of the femoral stem in patients with total hip replacements were reviewed after an average follow-up time of 5 (3-7) years. We were able to examine 38 of the patients. Surgery was performed in a standardized way through a posterior approach and with a dorsal proximal window in the femur. In 7 cases the femoral stem only was changed, while in 31 both components had to be replaced. The femoral components implanted were of the revision type, and were cemented and individually selected in each case. To stabilize large acetabular defects a combination of an acetabular support ring and a homologous bone graft was used in 21 cases; bank bone was used in a total of 28 hips. During surgery 1 fracture and 4 defects of the femur occurred. Good intraoperative stability of the femoral component was attained in every case, allowing full weight-bearing during mobilization unless acetabular instability was present. There were no deep infections. One dislocation had to be treated by closed reduction. Clinical evaluation was performed according to Merle d'Aubigné. Radiological loosening was classified according to Gruen, DeLee and Charnley. Clinical results were good in 33 (87%) and were rated as poor in 5. In the latter group a good correlation between subjective and objective parameters was noted in 4 of the 5 patients. Two acetabular and two femoral components in 3 patients were classified as radiologically loose; in 1 of these the cup was not changed at revision.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

Design of a surface replacement prosthesis for the proximal interphalangeal joint.

A surface replacement finger joint prosthesis was designed specifically for the proximal interphalangeal joint (PIPJ). The two-piece design consisted of a bi-condylar proximal phalangeal head and a conforming bi-concave middle phalangeal base. The bearing surfaces were designed as close to the original anatomy of the PIPJs as possible, using detailed information obtained from a previous anatomical study of 83 PIPJs by the present authors. Four sizes of prosthesis were designed with maximum head diameters of 7, 8, 9 and 10 mm. Fixation of the joint prosthesis was achieved by an interference fit between the stems of semicircular cross-section and the phalangeal bone shafts. The main considerations for the stem designs were the offset from the centre of rotation, angle of inclination, length, and cross-sectional shape and size. It is proposed that the two components will be made from cross-linked polyethylene (XLPE) because it can be injection moulded to produce the complex shapes of the joint prosthesis. In addition, XLPE against itself has shown comparable wear rates with stainless steel against ultra-high molecular weight polyethylene from previous work by Joyce et al.

Biocompatible Materials↗