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PubMed1993

Synthetic posterior cruciate ligament reconstruction and below-knee prosthesis use in Ehlers-Danlos syndrome.

Ehlers-Danlos syndrome (EDS) has been associated with irreparable arterial disruption, spontaneous and traumatic, necessitating amputation. Recurrent and chronic joint dislocation is a common component. Because of the very thin, hypermobile skin and "tissue paper scars," these patients would be expected to be poor candidates for the use of lower extremity prostheses. A review of the literature failed to show any reports of lower extremity prosthesis use in EDS patients or of recurrent and chronic joint dislocation treated by synthetic ligament reconstruction. The case of a 21-year-old woman is an example of both.

Adult↗
PubMed2001

The kinematic rotating hinge prosthesis for complex knee arthroplasty.

Fifty-eight patients (69 knees) treated with the Kinematic Rotating Hinged knee prosthesis for complex primary and salvage revision total knee arthroplasty were followed up for an average of 75.2 months (range, 24-199 months). The indications for use of the Kinematic Rotating Hinged knee prosthesis included severe bone loss combined with ligamentous instability (30 knees), nonunion of a periprosthetic fracture (10 knees), an acute periprosthetic fracture (nine knees), severe collateral ligamentous instability (five knees), reimplantation for infection (six knees), nonunion of a supracondylar femoral fracture (four knees), congenital dislocation of the knee (three knees), and treatment of a severely comminuted distal femur (two knees). At the time of surgery, the average patient age was 72 years (range, 46-92 years). Preoperatively, knee extension averaged 4.94 degrees (range, 0 degrees-40 degrees) and flexion averaged 81 degrees (range, 15 degrees-125 degrees). At final followup, knee extension averaged 1.25 degrees (range, -5 degrees-25 degrees) and flexion averaged 94.2 degrees (range, 5 degrees-125 degrees). The preoperative Knee Society Knee score averaged 40.3 points (range, 2-93 points) and improved to 77 points (range, 33-99 points) at final followup. Complications were numerous: 23 (32%) patients experienced at least one complication and 12 (17%) patients had two or more complications. Deep periprosthetic infection was the most common complication (14.5%), followed by patellar complications (13%), and prosthetic component breakage (10%). During the period of this study, there were 15,798 primary and 2673 revision total knee arthroplasties done at the authors' institution. The patients receiving a Kinematic Rotating Hinged knee prosthesis represent a highly complex and small subset (0.37%) of the overall population having knee arthroplasty. Although the use of the Kinematic Rotating Hinged knee prosthesis for these limited indications has been useful for the authors, the incidence of complications and the poor outcome of these complications is disconcerting. Hinged total knee arthroplasty should be reserved for the final salvage option of the treatment options available when doing complex primary and salvage revision knee arthroplasties.

Aged↗
PubMed1991

[Sled prosthesis, rotating knee and hinge prosthesis: St. Georg model and ENDO-model. Differential therapy in primary knee joint arthroplasty].

During the last 20 years the surgeons at the ENDO Klinik in Hamburg have implanted more than 7,000 cemented primary knee prostheses of their own design, formerly the St. Georg models and now the ENDO models. The sled prosthesis, rotating knee and hinge prosthesis are each stabilized to a different degree. The indication depends on the type of deformity, the disease. affecting the knee and the type of patient. As a result of our experience with the three systems they are now implanted in the ratio of 30:60:10, and we are convinced that in order to treat all problems encountered in diseased knees it is essential to have different prostheses with various degrees of stabilization.

Evaluation Studies as Topic↗
PubMed1976

[Knee joint prosthesis with the geomedic knee joint (author's transl)].

Thirty-one cases of plastic knee joint operations were reported. Twenty-one patients were treated with the geomedic knee. The advantage of this joint is that only a small amount of bone must be sacraficed. The range of movement is better than that with a complete knee prosthesis with axis.

Aged↗
PubMed1992

Listeria monocytogenes infection in prosthetic joints.

Listeria monocytogenes is increasingly recognised as a cause of prosthetic joint infection. These infections tend to be more insidious and indolent in contrast to similar infections with Staphylococcus aureus. They can occur in patients who are immunocompromised due to malignancy or other illness or in nonimmunocompromised elderly patients. Listeria infections should not be treated with cephalosporins and prolonged antimicrobial treatment is generally advised for prosthetic joint infections. We noted a high affinity of L. monocytogenes for foreign bodies. Three of twenty-seven cases 11%) of listeriosis under the period of investigation were associated with foreign bodies (hip prosthesis, knee prosthesis and arterial graft).

Aged↗
PubMed1998

[Osseous reconstruction of the patella with screwed autologous graft in the course of repeat prosthesis of the knee].

PURPOSE OF THE STUDY: The aim of this study was to propose an original way of solving the infrequent but difficult problem of a thin patellar remnant. After removal of the loose patellar button of a knee prosthesis, several options are available: patellectomy should be avoided because of unpredictable results; patelloplasty may be the solution if bone quality is too poor and can allow for its improvement with time; recementing a new implant needs the remaining patella to be thick enough (more than 10 millimeters). MATERIAL AND METHODS: We advised reconstruction with an autologous monocortical iliac bone graft, harvested from the medial cortex of the anterior iliac wing, and shaped to accommodate for the patellar remnant. Its cancellous surface is opposed to the roughened patellar bone to which it is fixed by four 1.5 mm cortical screws (the heads of which are countersunk). Any defect will be filled with cancellous chips. The patellar button can then be cemented. Two cases with a long follow-up (5 years) are shown: one is a "typical" indication of isolated patellar loosening 16 years after implantation of a GSB total knee prosthesis, in a 91 year old woman. The other one illustrates the salvage of a "patellectomized" multi-operated knee, in which a trochlear implant was used as a first step, then 4 years later the patellar pseudarthrosed remnant was reconstructed. DISCUSSION: Indications of this technique are obviously rare: the patellar remnant should be thinner than 10 mm, in one piece (or easy to rebuild with the graft), the bone should allow a good purchase of the screws and the extensor apparatus should be in continuity. The first cases seem encouraging, as no secondary fracture or non-union has been seen at five years follow-up. The bone-cement lucency seems to be due to cementing on a cortical surface, but did not increased. Autologous bone has been favoured to increase the chances of union in a poor quality bed. It has the drawback of a second approach to harvest the bone at the iliac wing, where it is not always flat. The surgeon must "cheat" to get as flat a surface as possible for cementing. The loss of quadriceps is so troublesome that Buechel has proposed autologous grafting inside the patellar tendon and Bakay has used a mushroom-shaped allograft. Finally, we should like to advise against too much thinning of the patella to try and gain a few more degrees of flexion in total knee replacement: think of revision! CONCLUSION: We think this technique may be helpful in patellar loosening, as an other way of solving this problem.

Aged↗
PubMed1981

[The dangerous blood clot in orthopaedic surgery (author's transl)].

104 patients who had been subjected to an orthopaedic procedure such as total hip prosthesis, knee prosthesis, or upper femoral osteotomy, have been studied by pre- and post-operative phlebographs. Calcium heparinate was given systematically after operation. It was noted that despite this regime, half of the patients showed thrombosis. The "dangerous" clot was situated in a main venous trunk and was unattached. Out of 79, 40 clots were said "dangerous". Four emboli were observed, of which one was fatal. Total hip prostheses were less dangerous than knee prostheses or osteotomies. A popliteal clot was more dangerous if traction was used post-operatively, and if the dose of heparin was only a preventive dose. Curative doses limited the extent of clots formed and decreased the likelihood of migration provided medication was started early. Pre-operative injection of heparin 2 hours before operation did not decrease the number of clots. Some other risks were also analysed. It was noted that early re-operation was accompanied by a very high risk. In such cases, preventive occlusion of the inferior vena cava may be justified.

Adolescent↗
PubMed2004

The Denham prosthesis in revision knee surgery: a 10 year follow-up.

We studied the Denham knee prosthesis (Biomet, Warsaw, IN) in revision of total knee arthroplasty (TKA) in situations of extreme bone loss or ligamentous disruption including revision from previous hinged implants. We reviewed 34 patients (38 knees) at an average of 7. 5 years after surgery (range 4-12 years). No patient was lost to follow-up although 15 unrelated deaths occurred during the study. There were six failures, of which five were due to infections in patients who received a revision for infection. A further two patients experienced a poor result. The remaining 30 patients had an excellent or good result. In our setting, the Denham TKA effectively addressed problems of loss of bone stock and ligamentous disruption with simple instrumentation and a remarkably small number of implants.

Aged↗
PubMed1991

[Hinge endoprosthesis of the knee joint. Long-term results based on the Blauth prosthesis].

Knee prostheses of the condylar or hinge type have constructional features that have both advantages and disadvantages. Both types are compromises as a result of different demands. Here we report long-term results with the Blauth prosthesis as an example of the efficiency of the hinge concept. The Blauth prosthesis is constructed according to the low-friction principle without a weight-bearing axis. Load transmission to the bone is accomplished by large interface areas. The sliding bearing of the patella is oriented perpendicular to the transverse axis of rotation. A prospective multicentric study reports on 511 prosthesis with a follow-up between 1 and 15 years. Aseptic loosenings were confirmed in 1.2% of the patients, deep infections in 3.3%. The survival analysis showed a probability of 89% that a prosthesis would not have a deep infection or loosen. A hinged knee prosthesis shows positive long-term results even compared with the condylar types if the relevant principles of construction are adequately considered.

Aged↗
PubMed1986

Bouncy knee in a semi-automatic knee lock prosthesis.

The Bouncy Knee concept has previously proved of value when fitted to stabilised knee units of active amputees. The stance phase flex-extend action afforded by a Bouncy Knee increased the symmetry of gait and also gave better tolerance to slopes and uneven ground. A bouncy function has now been incorporated into a knee of the semi-automatic knee lock design in a pilot laboratory trial involving six patients. These less active patients did not show consistent changes in symmetry of gait, but demonstrated an improved ability to walk on slopes and increased their walking range. Subjective response was positive, as noted in the previous trials.

Artificial Limbs↗
PubMed2005

[Femoral neck prosthesis in the case of femoral neck fracture and ipsilateral long stem-knee tumour prosthesis].

Femoral neck fracture in the case of a previously implanted ipsilateral tumour knee-prosthesis represents a challenging situation because of the long proximal stem of the knee implant. Avoiding total femur replacement, we implanted a femoral neck prosthesis (Eska Cut 2000) in a 65 year old patient to preserve as much of the femur free of implant as possible, minimizing the risk of a periprosthetic or interprosthetic fracture. At 2.5 years postoperatively, there were no signs of loosening, migration or periprosthetic fracture with a good functional result. In our case, the femoral neck prosthesis avoided the implantation of a total femur replacement. Nevertheless, this prosthesis must be considered critically and cannot be recommended as the standard implant for femoral neck fracture in the case of an ipsilateral long stem-knee prosthesis.

Aged↗
PubMed2004

The usefulness of 99mTc sulfur colloid bone marrow scintigraphy combined with 111In leucocyte scintigraphy in prosthetic joint infection.

AIM: To assess the extent to which bone marrow scintigraphy (BMS) makes the interpretation of leucocyte scintigraphy (LS) easier and improves its diagnostic value. METHODS: Seventy-three 111In LSs, 99mTc hydroxymethylene diphosphonate bone scintigraphies (BSs) and 99mTc sulfur colloid BMSs were performed in 60 patients with suspected infection related to a hip prosthesis or knee prosthesis, either in situ (+group, n = 43) or after removal for septic loosening (-group, n = 30). Bacteriological samples were obtained from all patients. LS was interpreted together with BS (LS-BS) or with BMS (LS-BMS) by three independent readers. RESULTS: The concordance among readers, estimated by the kappa test, was average with LS-BS (kappa/kappam coefficients = 0.58, 0.58 and 0.46, respectively, for the three pairs of readers) and excellent with LS-BMS (kappa/kappam coefficients = 1.00 for the three pairs of readers). With LS-BS, 64/219 interpretations were equivocal whereas only one was equivocal with LS-BMS. Sensitivity, specificity and accuracy of LS-BMS were, respectively, 80%, 94% and 91% in the +group, and 33%, 100% and 93% in the -group. CONCLUSION: We conclude that (1) the interpretation of the results for LS-BMS is very easy, in contrast to LS-BS; (2) the diagnostic value of LS-BMS for detecting infected joint prostheses is good; and (3) additional data are needed to assess the accuracy of LS-BMS when the prosthesis has been removed.

Adult↗