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The Christensen prosthesis. A retrospective clinical study.

The objective of this study was to determine if the Christensen temporomandibular joint prosthesis system in an effective alternative in treating patients with severe temporomandibular joint disorders. A total of 69 patients who were not responsive to either nonsurgical or prior surgical treatments were placed into one of three treatment groups depending on the following diagnoses: (1) placement of a glenoid fossa-eminence prosthesis with meniscus retention (22 patients, 40 joints); (2) placement of a glenoid fossa-eminence prosthesis without retention of the meniscus (26 patients, 49 joints); (3) total joint replacement (21 patients, 34 joints). Patients were evaluated immediately before surgery and at regular intervals after surgery for an average of 3.1 years. Success was measured as a significant improvement of function and decrease in pain as measured on a visual analogue scale, as well as improved incisor opening as measured with a Therabite Scale (Lorenz Surgical, Jacksonville, Fla.). Comparison of mean and average pre- and postsurgical values for all groups and criteria showed significant improvement. Results of this study indicate that the Christensen temporomandibular joint prosthesis system may offer a viable method for the treatment of severe temporomandibular joint disease with a high degree of success.

Adult↗

The compressible silicone rubber prosthesis in temporomandibular joint disease.

An alternative technique for temporomandibular joint arthroplasty is described, in which the mandibular condyle is replaced by a soft compressible silicone rubber prosthesis. A modified Nicolle-Calnan metacarpo-phalangeal joint prosthesis was used to reconstruct 31 joints in 24 patients. Results suggest that in those patients where there has been no loss of the prosthesis, function continues to be markedly improved when compared with the pre-operative condition. Painful symptoms were relieved in cases of specific joint pathology but the technique was of little value in the management of dysfunctional pain when radiographic evidence of joint pathology was absent. A specifically designed TMJ prosthesis of this type may be a useful addition to the surgeon's armamentarium.

Adolescent↗

Direct comparison of calculated hip joint contact forces with those measured using instrumented implants. An evaluation of a three-dimensional mathematical model of the lower limb.

Characterisation of hip joint contact forces is essential for the definition of hip joint prosthesis design requirements. In vivo hip joint contact force measurements have been made using instrumented hip joint prostheses. However, to allow determination of the range of values of joint contact force and their directions relative to anatomical structures in a range of subject groups sufficient to form an agreed data base it is necessary to adopt a different approach without the use of an implanted transducer. The use of mathematical models of the lower limb to examine the forces in soft tissues and at the joints has provided valuable insight into internal loading conditions. Several authors have proposed mathematical musculo-skeletal models. However, there have been only limited attempts at validation of these models. It is possible to use the results of in vivo force measurements from instrumented prostheses to validate the results calculated using the mathematical models. In this study two subjects with instrumented hip joint prostheses were studied. Forces at the hip joints were calculated using a three-dimensional model of the leg. Walking at slow, normal and fast speeds (0.97-2.01m/s), weight transfer from two to one leg and back again, and sit to stand were studied. Direct comparisons were made between the 'gold standard' measured hip joint contact forces and the calculated forces. There was general agreement between the calculated and measured forces in both pattern and magnitude. There were, however, discrepancies. Reasons for these differences in results are discussed and possible model developments suggested.

Computer Simulation↗

Artificial encapsulation of joint prostheses.

The great success of total joint replacement in surgery has been disturbed mainly by later loosening and wear-out of the plastic components. In an attempt to improve long term performance of joint prostheses and eliminate the adverse effects of wear debris, polymeric encapsulation as a main design feature has been proposed. The benefits of having an encapsulated and artificially lubricated joint prosthesis have been evaluated in tribological terms with particular reference to the UMIST shoulder joint. The selection of a number of biopolymers involved in this research project described. The possible interactions arising from the coexistence of these materials have been mechanically investigated. Much attention and a great deal of practical work has been focussed on the sealing of the capsule and on the relevant liquid permeability.

Humans↗

[The ochronosis disease picture and conservative and operative therapy. Presented in relation to a case report].

Ochronosis leads very early, already in the fourth decade, to osteoarthritic alterations, mainly of the large joints. As the treatment has to be symptomatic, joint prosthesis is often inevitable. We report about a case history of a patient with coxarthrosis and basic alterations by ochronosis. In spite of a bone structure similar those of osteomalacia, we were able to implant a cementless total hip prosthesis in the left hip joint.

Cartilage, Articular↗

The spherocentric knee: biomechanical testing and clinical trial.

The spherocentric knee is a non-hinged, intrinsically stable knee-joint prosthesis which allows controlled triaxial rotation and was designed specifically for use in severely deformed or grossly unstable knees. Biomechanical evaluation of the prosthesis implanted in fresh human cadaver limbs demonstrated highly favorable motion, stability, strength, deflection, and energy absorption characterists for the spherocentric prosthesis-bone assembly as compared with control cadaver knees. After an average follow-up of 25.5 months after the first twenty-five spherocentric arthroplasties, the clinical results were highly satisfactory and suggested that the spherocentric knee may be relatively resistant to the problems of wear debris, loosening, and breakage which have plagued other intrinsically stable knee-joint prostheses.

Aged↗

Total condylar prosthesis for alloplastic jaw articulation replacement.

Increasing attention has been paid to the development and testing of endoprostheses for the mandibular joint during the past few years. Theoretical considerations and knowledge of the compressive forces acting on this joint during rotational movements of the jaw induced us to concentrate our efforts on complete artificial joints right from the start. The clinical results obtained with individually-produced total endoprostheses made of Wisil for the mandibular joint are described. So far, 9 such artificial joints have been implanted in 6 patients. The post-operative assessment of jaw function by the patients, the clinical findings, tooth load measurements and jaw tracing were used to estimate the success of treatment. A total mandibular joint prosthesis which is completely different in regard both to material and shape of the artificial condyle, based on the experience gained so far, is presented.

Adult↗

Prosthetic joints, dental treatment, and antibiotic prophylaxis.

Dentists should be familiar with the newest antibiotic prophylaxis recommendations for joint prosthesis patients undergoing dental treatment. The guidelines identify physical conditions that place joint patients at the highest risk for joint sepsis. They also stratify dental procedures into higher- and lower-risk categories. Combining these two groupings clarifies the dentist's strategy for antibiotic prophylaxis regimens, which are greatly simplified. Of notable importance is the elimination of posttreatment antibiotic dosing. A large group of patients who do not require antibiotic prophylaxis prior to dental treatment are also identified by the guidelines. Every dentist must use clinical judgment, knowledge of the patient, and consultation with the attending physician to determine the appropriate treatment plan.

Antibiotic Prophylaxis↗

Ultrastructure of collapsed metatarsophalangeal silicone elastomer implant.

The use of silicone elastomer implants in podiatric surgical practice is presently a well accepted treatment modality. However, there are instances of failure, and the present study describes a total collapse and fragmentation of a metatarsophalangeal joint prosthesis. Defects are demonstrated by scanning electron microscopy, while physical and chemical reasons for the occurrence as stated in the current literature are reviewed.

Biomechanical Phenomena↗

[Clinical outcomes of treatment of glenohumeral osteoarthritis with new generation shoulder prosthesis].

OBJECTIVE: To investigate the clinical effects of arthroplasty with UNIVERS 3-D prosthesis, the representative of fourth generation of shoulder joint prosthesis proved to be more suitable to shoulder anatomy, in treatment of glenohumeral osteoarthritis. METHODS: Seventy-four patients with glenohumeral osteoarthritis, aged 67.07 (47 - 84), received shoulder arthroplasty with UNIVERS 3-D prosthesis and were followed up for 31.9 months (12 - 74 months). Roentgenography was conducted to observe the acromion, and acromion-humeral distance (AHD), glenohumeral distance (GHD), humerus height (HH), and humerus width (HW). Constant scoring and normalized Constant scoring were used to evaluate the function of the shoulder joint. RESULTS: The Constant score at the last follow-up was 68.40 +/- 16.91 points, significantly higher than that at beginning (34.094 +/- 15.00, P < 0.05), The normalized Constant score at the last follow-up was 92.27 +/- 22.53%, significantly higher than that at the beginning (45.29 +/- 19.87%, P < 0.05). The post-operative pain, daily life, activity score, and myodynamia scores were all significantly higher than those evaluated pre-operatively (all P < 0.05). Pre-operative roentgenography showed 93.47% of the cases with humeral head periarticular osteophytes located at the inferior side; 36.96% with humeral head necrosis; 8.69% with humeral head cyst; and 39.13% with periarticular osteophytes of glenoid, and showed that AHD was shortened (1.83 +/- 1.64 mm), and GHD, HH, and HW were all narrowed (10.91 +/- 3.03 mm; 5.71 +/- 4.32 mm, and 3.34 +/- 4.82 mm respectively). After the operation, the AHD, GHD, and HH were all significantly increased, and HW did not significantly changed. The humeral inclination angle was changed postoperatively from 126 degrees to 142 degrees. The incidence of radiolucent lines around the prosthesis of humeral shaft was 5.41%, most in the zones d, c, and e, all with the radiolucent index of less than 1. The overall complication rate was 12.2%. CONCLUSION: Treatment of glenohumeral osteoarthritis with UNIVERS 3-D prosthesis effectively reconstructs the anatomy of glenohumeral joint, and shows excellent clinical results with low incidence of radiolucency and postoperative complications.

Aged↗

Update on prosthetic joints, dental treatment, and antibiotic prophylaxis.

At this time, all dentists and physicians should be very familiar with the 1997 ADA/AAOS antibiotic prophylaxis recommendations for joint prosthesis patients who are undergoing dental treatment. The guidelines identify physical conditions that place joint replacement patients at the highest risk for joint sepsis. They also stratify dental procedures into higher-risk and lower-risk categories. Combining these two groupings clarifies the dentist's strategy for antibiotic prophylaxis protocols, which are greatly simplified over previous practices. Of notable importance is the elimination of posttreatment antibiotic dosing, the reduction of the loading dose of antibiotic, and the identification of a large group of joint replacement patients who do not require antibiotic prophylaxis prior to dental treatment. Every dentist must use clinical judgment, knowledge of the patient, and consultation with the attending physician to determine the appropriate treatment plan.

Amoxicillin↗

[Functional study of Swanson's metacarpophalangeal arthroplasties in rheumatoid arthritis].

To validate a functional hand evaluation and to obtain an historical control group in a project of metacarpophalangeal total joint prosthesis, we reviewed our experience over a ten year period of Swanson's metacarpophalangeal joint arthroplasty in rheumatoid arthritis. Forty-nine implants in fourteen rheumatoid arthritis patients were reviewed clinically, radiologically and evaluated by the Arthritic Hand Function Test. The mean follow up was 4.5 years. All patients were ready to repeat the experience except one. The mean metacarpophalangeal joint range of motion was 37 degrees (18 degrees to 55 degrees) with a mean of 7 degrees ulnar deviation. Although their functional performance was 50% of normal, all patients completed the test. The strength was generally greater on the operated side. The low complication rate (6% fracture rate) with the successful functional outcome of Swanson's metacarpophalangeal joint arthroplasty in rheumatoid arthritis will be the gold standard for any new implant to develop.

Adult↗

[Joint prostheses].

Since 34 years, many improvement occurred. Joint prosthesis have to be anatomic, simple, thin and not a large foreign body. New material are warranted for their solidity. Many types are manufactured. The most used are hip prosthesis. Junction between bone and prosthesis is not solved as yet. Acrylic cement was on interface junction but in order to solve the failures, new porous or rough surface materials allowed anchorage by the bone itself. Prosthesis longevity is limited by bone prosthesis interface. Prosthesis replacement is possible and will develop.

Humans↗