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At least 793 records · Page 44Linked to original sources
PubMed2004

Currently available metacarpophalangeal prostheses: their designs and prospective considerations.

Although implanted for over 40 years, finger prostheses have failed to match the success achieved by artificial hip and knee prostheses, despite a myriad of designs having been proposed and implanted. This article looks at the currently available designs of metacarpophalangeal prosthesis, both single-piece and multicomponent implants. An appraisal of their designs and the clinical results, where available, are provided. The review also considers the challenges that are still faced by bioengineers and surgeons concerned with improving the success of metacarpophalangeal prostheses. In addition, key current areas of concern such as in vitro testing and contemporary issues in rheumatology, which may be diminishing the amount of metacarpophalangeal arthroplasty taking place, are discussed.

Arthroplasty, Replacement, Finger↗
PubMed1995

Cathepsin G and alpha 1-antichymotrypsin in the local host reaction to loosening of total hip prostheses.

The tissue localization and content of the proteolytic enzyme cathepsin G and its inhibitor alpha 1-antichymotrypsin were studied in the local host reaction to loosening of total hip-replacement prostheses in eleven patients and were compared with those in samples of non-inflammatory tissue from the synovial capsule obtained during arthroscopies of the knee. Immunostaining demonstrated cellular localization of cathepsin G in 71 per cent of monocyte or macrophage-like cells and in 46 per cent of fibroblast-like cells in the samples of interface tissue between the bone and the loose acetabular component obtained at the time of the total hip replacements, and in 59 and 42 per cent, respectively, in the samples of pseudocapsular tissue obtained at the same time, whereas the synovial lining cells in the samples of non-inflammatory tissue from the synovial capsule revealed only a slight immunoreactivity to cathepsin G. Cathepsin-G activity was also measured with synthetic succinyl-alanine-alanine-proline-phenylalanine-paranitroanilide as a substrate, the degradation of which was monitored spectrophotometrically. In accordance with results from immunohistochemical studies, cathepsin-G activity was found in the samples of interface tissue (31.6 international units per liter) and the samples of pseudocapsular tissue (15.5 international units per liter) obtained during the total hip replacements, whereas the level of cathepsin-G was low in the samples of non-inflammatory synovial capsular tissue (2.5 international units per liter). Cathepsin-G activity in the samples of pseudosynovial fluid obtained at the time of the total hip replacements was low (2.4 international units per liter), although immunoblot analysis showed marked immunoreactive cathepsin G in the samples of pseudosynovial fluid. This low activity of cathepsin G might be explained by the presence of alpha 1-antichymotrypsin, which was detected by laser nephlometric immunoassay and immunoblot analysis. These results demonstrate increased concentration of cathepsin G locally in the tissues around loose total hip-replacement prostheses. Because cathepsin G is not only able to act on extracellular matrix components (such as gelatin, proteoglycan, elastin, and laminin) at a physiological pH but also is able to activate collagenase, gelatinase, and stromelysin proenzymes, to inactivate tissue inhibitor of metalloproteinases, and to modulate tumor necrosis factor-alpha, it may play an important role in the degradation of periprosthetic connective tissue and in the lysis of bone around the implant, thus contributing to the loosening of prostheses.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2006

Impact of prostheses on function and quality of life for children with unilateral congenital below-the-elbow deficiency.

BACKGROUND: Children with unilateral congenital below-the-elbow deficiency present a dilemma to clinicians. Parents want the child to have a prosthesis and, because it seems that the deficiency will cause functional problems, one is customarily prescribed for infants. Use of the prosthesis is then encouraged throughout childhood. However, these children frequently abandon the prosthesis. There are no evidence-based guidelines regarding prescription of prostheses or standard methods for assessing use and function. METHODS: A multicenter outcomes study was done to assess the quality of life and function of 489 children with a unilateral congenital below-the-elbow deficiency; 321 wore a prosthesis, and 168 did not. The Unilateral Below-the-Elbow Test (UBET) was designed, validated, and administered to these children along with several outcomes measures, including the Pediatric Outcomes Data Collection Instrument (PODCI), the Pediatric Quality of Life Inventory (PedsQL), and the Prosthetic Upper Extremity Functional Index (PUFI). RESULTS: Use of a prosthesis was not associated with any clinically relevant differences in PODCI or PedsQL scores. Non-wearers performed either the same as or better than wearers on the UBET. When queried (with use of the PUFI) about performance of various tasks, non-wearers scored themselves higher than wearers. Children with a unilateral congenital below-the-elbow deficiency scored the same as or higher than the general population on the PedsQL. They scored significantly lower than the general population on the PODCI Upper Extremity Physical Function Domain and higher on the Happiness Domain, but the differences were small. CONCLUSIONS: Prostheses may help with social acceptance or may be useful as tools for specialized activities, but they do not appear to improve function or quality of life, which are nearly normal for children with unilateral congenital below-the-elbow deficiency regardless of whether they wear a prosthesis. These findings call into question the standard practices of fitting infants with prostheses and encouraging young children to wear the prosthesis.

Adolescent↗
PubMed1994

Indwelling tracheo-oesophageal voice prostheses post-laryngectomy in Sheffield, UK: a 6-year review.

The Groningen and Provox tracheo-oesophageal valve voice prostheses have been used in post-laryngectomy patients extensively in Sheffield since 1986 and 1990, respectively. To the present time a total of over 40 patients have made use of these devices, two thirds of whom underwent insertion at the time of laryngectomy. Prostheses were replaced under local or general anaesthesia if they were leaking or if phonation became increasingly difficult. Our experience with over 200 valves including the Groningen High Resistance, Groningen Low Resistance and Provox prostheses in this patient group is presented. We believe that the primary insertion of a low resistance prosthesis, either the Provox or Groningen Low Resistance device, is the method of choice in speech rehabilitation following laryngectomy.

Adult↗
PubMed1977

A system of extension prostheses.

It is suggested that three basic types of extension prostheses are required as shown in Figure 1. Four methods of achieving these prescriptions using rigid, total-contact, polyester laminate sockets have been described, and the table (Fig. 6) indicates the correct method to be used for each type. These prostheses have proved very durable and repairs have been limited to replacing the straps and foot coverings. Advantages claimed are improved comfort, efficiency, and appearance, in addition to speed of fabrication and lightness when compared with conventional prostheses.

Adult↗
PubMed1978

Prostheses, pain and sequelae of amputation, as seen by the amputee.

Results of a survey of 19 organizations belonging to World Veterans Federation indicate that major complains of amputees include; poor fitting, poor dissemination of knowledge to doctors and amputees regarding new prostheses, lack of opportunity for "input" from amputees at research level and inadequate measures to deal with phantom and stump pain. Suggested improvements by amputees; decrease in weight of prostheses, reduction in maintenance for swing and stance-phase control units development of recreational prostheses, more frequent checks through use of X-ray and film techniques, particularly during the "break-in" of a new appliance. Older veterans showed increasing concern in regard to development of consequential disabilities arising from amputation; premature arthritic changes in spine and remaining limb, circulatory problems and gastro-intestinal problems due to ingestion of drugs to control pain.

Adaptation, Psychological↗
PubMed1988

Traumatic amputation of the upper limb: the use of body-powered prostheses and employment consequences.

Forty three patients with unilateral traumatic amputations were reviewed as to the use of prostheses and employment consequences of the amputation. Seventeen of 19 below-elbow amputees, and 12 of 24 above-elbow amputees used their prostheses. Non-users compared to users of prostheses were characterized by: 1) Higher level of amputation 2) Non-dominant arm amputation and 3) Younger age at the time of amputation. However non-users usually did well on the labour market for various reasons.

Adult↗
PubMed1993

Consumer concerns and the functional value of prostheses to upper limb amputees.

This paper reports a study of 66 upper limb amputees in County Funen, Denmark who were visited in their homes by the author. The purpose of the study was to evaluate the consumer concerns about their prostheses and to see if these were related to cessation of prosthetic use. It was also intended to estimate functional levels of both prosthetic users and non-users. The number of amputees investigated corresponds to the annual number of persons becoming upper limb amputees in Denmark. There were 3 prosthetic systems in use, two active systems and one passive system. At review there was a group of 18 amputees which did not use a prosthesis at all. It appeared that active and partially active users are younger persons with a relatively short time-lapse since amputation. Passive users are older persons with a long time-lapse since amputation. Only 4 out of 18 prosthetic non-users stopped prosthetic use as a consequence of prosthetic problems or discomfort. Active prostheses had the highest number of consumer problems. Most problems were concerned with the socket, and for the body powered prostheses also with the suspension and control system. It was shown that an awareness of the amputee's working conditions is important at the fitting stage, especially the daily working situation. As a consequence strictly individual fitting is needed with attention being given to the manner in which the individual will use the prosthesis. This investigation clearly shows that active fitting is a worthy effort. In daily living the active users have a superior performance over the passive and non-users. It was observed that amputees despite many years of training still have problems with activities of daily living, particularly in relation to independent functions.

Activities of Daily Living↗
PubMed1997

Fungal colonisation in digital silicone rubber prostheses.

The fungal discolouration of silicone rubber prostheses is reported in four cases. In two of the cases, the discolouration was caused by the fungus Candida tropicalis. In the other two cases, two different fungal organisms, namely Trichoderma sp. and Scedosporium prolificans were incriminated. The non-porous silicone rubber layers create an enclosed environment in the suction cup of the prosthesis and preclude ventilation at the prosthesis-stump interface. The moisture as a result of sweat and body warmth in the stump assists fungal growth. Residual salts from the sweat, sebum from sebaceous glands and the residues from petroleum jelly (Vaseline) applied to facilitate donning, can adhere to the surfaces of the prosthesis and provide the nutrients for fungal growth. Prolonged continuous usages of the prosthesis, the presence of sweaty palms in the users, donning the prosthesis during manual physical activities which induce perspiration, washing of hands with the prosthesis on and warm humid climatic conditions have been identified as factors predisposing the prosthesis to fungal colonisation. The fungal growth caused a black discolouration and marred the aesthetic quality of the prostheses. As a preventative measure, daily immersion of the prostheses in denture cleaner such as benzalkonium chloride, or water at 60 degrees C for 15 minutes, or decontamination with 70% alcohol is recommended. Prior cleaning to remove organic matter before decontamination is emphasised.

Biocompatible Materials↗
PubMed1998

An evaluation of the use made of cosmetic and functional prostheses by unilateral upper limb amputees.

There is currently a distinction drawn between a prosthesis considered to be provided for purely cosmetic reasons and a functional prosthesis provided to enable the amputee to achieve basic hand function. Using video analysis the study reported in this paper demonstrates that for non-manipulative actions cosmetic prostheses are actively used in the performance of everyday tasks as frequently as functional prostheses. The study provides evidence for a cosmetic prosthesis to be presented to an amputee as a realistic initial prosthesis and not as the option of last resort if a functional prosthesis is rejected. It is also recommended that training is provided in the use of cosmetic prostheses in two-handed tasks.

Adolescent↗
PubMed1988

Evaluation of reimplant total hip prostheses and resection arthroplasty.

Results of reimplanted total hip prostheses and resection arthroplasty were compared. Using the Iowa hip rating scale, the reimplanted prostheses population was rated higher for function, gait, and absence of deformity, however, the resection arthroplasty population rated better in freedom from pain. Radiographic findings in the reimplanted prostheses population included radiolucent lines around the cement, loosening, and cortex bone stock loss. These findings cause concern for the future of these implants. Repair and remodeling of the bone lesions were observed in resection arthroplasties. It was concluded that if healing of infection is achieved or if resection is performed for mechanical failure, the results may be considered permanent.

Adult↗
PubMed1991

Variation in applied force during insertion of cemented femoral prostheses.

Information is presented on forces applied to cemented prostheses during insertion. An instrumented femoral pusher was used to collect information during simulated operations on cadavers while using a laboratory test rig and during live surgery. Surgeons using flanged or collared prostheses tend to apply more force than those using collarless prostheses. There is a tendency for abrupt changes in applied force to occur when: 1) clearing cement; 2) easing hand discomfort; and 3) testing cement consistency. Tests showed that an overall impression of the force applied could be obtained from a laboratory simulation, but that clearing cement and testing cement were not modelled by this method. We discuss the implications of our observations in terms of prosthesis fixation and training of staff.

Biomechanical Phenomena↗
PubMed1999

Intermediate-term clinical and radiographic results of Synatomic and AGC knee prostheses.

This study compared two total knee prostheses to determine whether the clinical and radiographic outcomes were different, focusing primarily on the patellofemoral articulation. The study group was comprised of 75 Synatomic (short-stemmed, anatomic VF type) and 79 AGC 2000 (universal, nonanatomic) prostheses. Patients underwent follow-up for an average of 63 and 50 months, respectively. At latest follow-up, the mean knee joint score was 84.4 in the Synatomic and 86.5 in the AGC group. Mean knee function scores were 63.5 and 63.4, respectively. No statistically significant difference was noted between the two prostheses.

Aged↗
PubMed1998

In vitro and in vivo comparison of the low-resistance Groningen and the Provox tracheosophageal voice prostheses.

This study has been performed to evaluate and compare two frequently used indwelling tracheoesophageal voice prostheses, the low-resistance (LR) Groningen and the Provox voice prosthesis. The airflow resistance in vitro of the Provox prosthesis has been measured and compared to our reported results of the LR Groningen prosthesis. The in vivo study involved fifteen non-myotomized laryngectomees who randomly received one of the two prostheses. Measurements were performed of the intratracheal phonatory pressure and of voice parameters. The intelligibility of speech in noise was evaluated in eight patients. Patients preferences regarding the two prostheses were assessed. Aerodynamic measurements show the Provox voice prosthesis to have a lower airflow resistance. The median intratracheal phonatory pressure for phonation of 75 dB was significantly lower (2.1 kPa) in patients using the Provox voice prosthesis. Speech rate, maximal phonation time and maximal vocal intensity showed no significant difference. The intelligibility of speech in noise produced with the Provox was significantly better than the speech produced with the LR Groningen prosthesis. Subjectively, most patients preferred the Provox prosthesis because speech required less effort. Patients with a hypotonic pharyngoesophageal segment tended to prefer the LR Groningen prosthesis.

Adult↗
PubMedDate not supplied

[The use of Dacron prostheses in laparoceles].

BACKGROUND: Purpose of the study was to evaluate indications and efficacy of Dacron prostheses in the treatment of incisional hernias. METHODS: The study has been carried out in a retrospective way; mean follow-up has been 20 months. Surgical setting has been the Institute of Emergency Surgery at the University of Catania, where about 500 abdominal operations are performed every year. Thirty patients affected by incisional hernias have been considered (mean age 66.8 years). In 12 patients the Mayo technique was performed, whereas a Dacron prosthesis was placed in 18 patients. Other than early postoperative complications, patients have been followed by periodical clinical exams in order to find out possible recurrences as well as other late complications. RESULTS: Among 18 patients treated with insertion of Dacron prosthesis no infection, recurrence, bowel fistula, haematoma or dislocation have been observed. Only in one case an intestinal occlusion secondary to adhesions between prosthesis and bowel has occurred; in this patient a new operation has been necessary to remove the prosthesis. CONCLUSIONS: Considering that prostheses have been used in large incisional hernias or in patients with a weak abdominal wall, the high successful percentage (94%) obtained suggests the use of Dacron prostheses which guarantee long stability and minimum risk of recurrences.

Abdominal Muscles↗
PubMed1976

[Significance of various implantate localizations of Sparks prostheses, experimental studies in rats].

Our investigations show that Sparks prostheses after subcutaneous implantation are suitable for vascular grafting. At the end of the organization period the connective tissue becomes strong, and after the third and fourth weeks collagenous and elastic fibers can be seen. Ten weeks after s.c. implantation, collagenous fibers predominate. After this the Sparks prostheses can be used as a vascular graft. Intraperitoneal implantation, however, shows a histologically different picture with characteristic findings: only fat cells can be observed, a strong granulation tissue with elastic and collagenous fibers is not present. After intraperitoneal implantation Sparks prostheses are therefore unsuitable for vascular grafts.

Animals↗
PubMed1976

Current status of porcine heterograft prostheses: a 5-year appraisal.

Between 1970 and 1975, 234 porcine heterograft valve prostheses were implanted in 193 patients with 12 operative (6%) and 21 late deaths (11%). Detailed hemodynamic studies were made 6 months to 1 year following operation in 72 patients. Mean atrioventricular (A-V) diastolic pressure gradients averaged 5.2 mm Hg for 29 mm heterografts and 2.3, 2.5, and 2.7 mm Hg for 31 mm, 33 mm, and 35 mm heterografts, respectively. In 10 patients with aortic prostheses peak systolic gradients averaged 16 mm Hg at rest (range 0-26) but increased to 70 mm Hg during exercise (range 20-125). Anticoagulants were not used except when intracardiac clot was present at operation. There were 12 systemic arterial emboli, all with mitral prostheses and low cardiac output; nine patients were in atrial fibrillation and three were in sinus rhythm. Three patients evidenced late tissue failure. Hydraulic function in the A-V position is excellent: prosthetic valve size is not limited by tertiary orifice and A-V anulus accepts large prosthesis. The patient's anulus is the determinant of aortic prosthesis size; heterograft internal diameter to outside diameter ratio is suboptimal and hydraulic function of the aortic prosthesis is marginal. In our clinical practice we consider the performance characteristics of currently available valves in relation to the individual patient's priorities to select an appropriate prosthesis.

Animals↗
PubMed1999

Fabrication of resin-bonded three-unit prostheses.

This article describes the fabrication of two fiber-reinforced poly-glass ceramic three-unit fixed prostheses. A second-generation laboratory-processed polymer-glass ceramic material (Sculpture) that utilizes a resin-impregnated translucent fiber framework (Fiberkor) was used to fabricate two fixed resin-bonded prostheses. The abutment teeth of one appliance required the use of a full coverage preparation and an inlay design. The other prosthesis required an inlay preparation and onlay configuration. Two three-unit provisional prostheses were fabricated and inserted using eugenol-free temporary cement. With the fabrication of the fixed appliances, they were bonded to the abutment teeth with resin cement. The insertion of the two fixed appliances using the polymer-glass ceramic material provided the esthetic advantage of translucency, while avoiding the appearance of metal.

Composite Resins↗