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At least 631 records · Page 35Linked to original sources
PubMed1993

Managing infection in the revision total hip replacement patient.

Deep infection is one of the most devastating complications in total hip replacement. This dreaded complication is presented in considerable detail with special emphasis on prevention, diagnosis, and various methods of surgical and antibiotic treatment. Basic fundamentals of antibiotic therapy are reviewed. In addition, guidelines are given for the indications of surgical intervention, the type and staging of operative procedures, with detailed techniques of the various operative procedures used to treat the infected total hip implant patient.

Anti-Bacterial Agents↗
PubMed1990

Primary bipolar total hip arthroplasty.

A retrospective clinical and radiographic review of 140 primary total hip arthroplasties using a bipolar acetabular component and an uncemented AML femoral component (Depuy, Warsaw, IN) was done. The length of follow-up was from 2 to 5 years with a mean of 44.2 months. A mean postoperative Harris hip score of 84.3 points and a mean postoperative Harris pain score of 38.8 points were identified. Five hips required revision surgery, three for recurrent dislocations and two for infection. Nine percent of acetabular components were noted to have migrated within the bony pelvis by 2 mm or more. However, the presence of migration was not statistically associated with low pain or function scores. Ninety-eight percent of patients with surviving implants felt satisfied with the results of their surgery. Total hip arthroplasty using a bipolar acetabular component appears to be a successful method of hip replacement.

Adult↗
PubMed1995

Experience with the penile prosthesis and artificial urinary sphincter.

The therapy of two common urologic problems, erectile dysfunction and urinary stress incontinence, has been revolutionized over the last 20 years by the incorporation of principles of hydraulic mechanics into the field of silicone prosthesis implantation. The inflatable penile prosthesis is surgically implanted into men with impotence due to organic or psychogenic etiology. The artificial urinary sphincter has found widespread use in males and females in both the adult and pediatric populations with stress incontinence from a variety of causes. Associated with these popular devices are various complications relating to the anatomic site as well as the host's immunologic response. The use of these implants, as well as the technologic innovations resulting from various adverse effects, are reviewed herein.

Erectile Dysfunction↗
PubMed1999

[The complications of implantable cardioverter-defibrillators and their treatment].

Infection of implantable cardioverter defibrillator (ICD) is a devastating event. In an effort to more fully understand ICD infection, the authors reviewed patients records recommending a strategy for management based on their satisfactory experience. From March 1993 through May 1998, 85 ICD were implanted in 64 male and 21 female patients. Transmediastinal approach was performed in 8 (9.5%) cases and transvenous in 77 (91.5%). All device-related infections were examined. Seven (8.25%) device-related infections occurred with a mean time interval of 3 months. In all cases bacterial infection was demonstrated. All infections involved the generator with or without other components involvement. First approach was conservative in all cases but it wasn't successful. Then the authors always used a surgical therapy, in 3 cases removing electrodes by traction and in 4 resorting to cardiopulmonary bypass (CPB). Two deaths were registered. Explantation of ICD resolved in all cases infective complications with no early or additional reinfections. In the last cases with devices implanted by transvenous approach and subpectoral generator implant, no infective complications were observed. In authors experience a complete removal of the ICD generator as well as of all its components is to be preferred as soon as the infections develops.

Adult↗
PubMed1999

Prosthetic replacement in the management of unstable femoral neck fractures in the elderly. Analysis of the mechanical complications noted in 778 fractures.

From 1987 to 1996, 778 unstable fractures of the femoral neck Garden type III or IV in 736 patients over 70 years of age have been treated surgically. Based on age and functional preinjury status, 477 patients were treated with a hemiarthroplasty; a total hip prosthesis was implanted in another 301 patients. The overall mortality rate at one year was 20%. Of the 472 surviving patients pre-operatively classified as "independent", 68% regained an independent active level; in the remaining 32%, the femoral neck fracture caused an important additional impairment. One also has to admit that the complications after prosthetic replacement are not harmless: dislocation (2%) requiring an early revision arthroplasty in about half of the cases; deep infection (< 1%) leading to a Girdlestone situation and sometimes even to death. It is generally accepted that, if prosthetic surgery is chosen, the best implant for this category of patients is a bipolar system. Despite good functional results observed after total hip arthroplasty for fractures, we recommend this technique only in selected cases. The risk for prosthetic loosening is also much higher after replacement for fracture than after replacement for osteoarthritis (at least 14% within 5 years). Nevertheless, we prefer a total prosthesis implant in patients with a good life expectancy and good functional condition, aged between 70 and 80 years, presenting a severely displaced unstable fracture.

Activities of Daily Living↗
PubMedDate not supplied

Evaluation and management of malfunctionings following implantation of the artificial urinary sphincter.

The authors report their experience of mechanical malfunctionings after placement of the AMS 800 artificial urinary sphincter. The aim of the study was to suggest outlines for the evaluation and management of these complications. From 1991 to 1998, 42 patients (39 men, 3 women with a mean age of 67.5 years) underwent artificial sphincter implantation of whom 5 patients required explantation of the prosthesis because of infection. The following mechanical malfunctionings occurred: 2 cases of air bubbles; 3 cases of pump overturning with tube kinking; 16 cases of persistent or recurrent incontinence 6-61 months postoperatively; and 1 case of cuff opened during sexual intercourse. Surgical revision of the prosthetic components was performed in the patients who presented mechanical malfunctionings. Several complications can arise after artificial sphincter placement (infection, urethral erosion, mechanical malfunction). In the last case, the authors stress the importance of an accurate diagnosis for the choice of exact treatment.

Aged↗
PubMed1999

[Complications after joint endoprosthesis for treatment of locomotor system neoplasms].

The authors present most common complications after tumor related joint replacement. Twenty-six patients (9 females, 17 males) have been operated on (mean age 22.5 years). In 19 cases osteosarcoma was diagnosed, Ewing sarcoma in 4 and there were 3 cases of chondrosarcoma. Postoperatively, superficial skin necrosis occurred in 4 patients but healed in four weeks, full-thickness skin necrosis in 2 and in 2 cases wound infection resulted in septic loosening of endoprosthesis. The number of infections in our patients was low but caused delay of chemotherapy and need for revision of the infected joint.

Adult↗
PubMed1999

Pathology of the bone-implant interfaces.

Joint replacement surgery has a wide clinical application as a successful technique. However, the release of biomaterial in particulate form from various implant components has been implicated as a cause of two major clinical complications: 1) bone lysis with or without aseptic loosening, and 2) dissemination of wear particles to distant sites with adverse local or systemic cellular responses. This review focuses on the analysis of the clinical material obtained at the time of revision operations and its value in identifying the pathological processes taking place within the bone-implant microenvironment. Important issues discussed include the incidence of infection, characterization of wear particles, particle-cell interactions, local histopathological changes that lead to the formation of erosive inflammatory lesions next to the bone, sensitivity reactions, tumor formation, and the induction of inflammatory factors and cytokines that can influence the rate of bone resorption versus bone formation.

Biocompatible Materials↗
PubMed2001

[Antigranulocyte scintigraphy of septic loosening of hip endoprosthesis: effect of different methods of analysis].

AIM: Diagnosis of infection with help of antigranulocyte scintigraphy near body stem is difficult because of contemporary visualisation of bone marrow. Therefore, we investigated, whether it is possible to improve the accuracy in diagnosing septic loosening of hip endoprosthesis by changing the analyzing methods. METHODS: In 28 patients, the results of a visual interpretation of late scan, a visual interpretation and a quantitative interpretation of time-activity-course were compared. These results were verified by histology respectively microbiology. RESULTS: Histological and microbiological verification found 14 septic loosening and 14 aseptic loosening of the hip prothesis. Therefore, sensitivity, specificity, negative and positive predictive value for the visual interpretation of late scan were 0.86, 0.57, 0.80 and 0.67. For visual and quantitative interpretation of time-activity-course we found 0.86, 0.79, 0.85 and 0.80 respectively 1, 0.93, 1, 0.93. For interobserver agreement we found kappa coefficients of 0.28 +/- 0.2 for visual interpretation of late scan, 0.48 +/- 0.17 for visual interpretation and 1.0 +/- 0 for quantitative interpretation of time-activity-course. CONCLUSION: In all investigated values quantitative interpretation of time-activity-course was superior to the other analyzing methods. Therefore, antigranulocyte scintigraphy for septic loosening of hip endoprosthesis should be interpreted quantitatively.

Antibodies, Monoclonal↗
PubMed2001

Temporary articulating methylmethacrylate antibiotic spacer (TAMMAS). A new method of intraoperative manufacturing of a custom articulating spacer.

A temporary articulating antibiotic-impregnated cement spacer for use during the first stage of a two-stage revision of a total knee replacement that had failed because of infection was developed by one of us (W.M.G.). It is simply a knee prosthesis made of methylmethacrylate and antibiotics that is manufactured intraoperatively with use of instruments, medications, and supplies that are already available at most hospitals. This construct allows for motion of the knee during treatment of the infection, thereby reducing the risk of loss of motion after subsequent revision. The technique has been successfully utilized in five patients since 1999 and has now become our standard treatment method.

Anti-Bacterial Agents↗