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PubMed2003

[Total elbow arthroplasty in rheumatoid arthritis using GUEPAR prosthesis].

PURPOSE OF THE STUDY: We report a retrospective analysis of 16 patients with rheumatoid arthritis treated with a total humero-ulnar and humero-radial GUEPAR prosthesis (GIII). MATERIAL AND METHODS: The GUEPAR III elbow prosthesis is an anatomic polyethylene-metal gliding prosthesis designed to maintain physiological valgus. Right and left models are available in two sizes. On the humero-ulnar side of the prosthesis, was associated with a radial head, born on an intramedullary metallic stem, that can be fit with several sizes of mobile polyethylene cups. The 16 GIII prostheses were implanted in 1997 to 2001 in accordance with the manufacturers instructions. Mean follow-up was 2 years. RESULTS: Before surgical treatment, all patients had moderate or severe but invalidating pain. The Mayo Clinic score was 33 points. The Larsen radiographic score was grade III (7 elbows) or grade IV (9 elbows). Patients were reassessed 1 to 5 years after implantation of the GIII (mean follow-up 2 years). At last follow-up the mean Mayo Clinic score had improved from 33 to 90 points. Outcome was considered excellent for 15 elbows and fair for 1. DISCUSSION: We review the indications for total elbow arthroplasty in patients with rheumatoid arthritis. Semi-constrained prostheses are useful and necessary for the treatment of elbows exhibiting massive destruction, but the use of minimally constrained prostheses such as the GUEPAR III is becoming increasingly widespread. We use the GUEPAR III for 70% of our patients, particularly those with rheumatoid arthritis.

Adult↗
PubMed2004

[Medial unicompartmental knee prosthesis for patients with unicompartmental gonarthrosis].

The function and survival time of unicompartmental knee prostheses for patients with severe gonarthrosis have been improved the past few years by developments in their design, the instrumentarium and the surgical technique. A medial unicompartmental knee prosthesis may be indicated in patients with arthrosis of the medial tibiofemoral compartment. The prerequisites are an intact anterior cruciate ligament, an intact lateral compartment, a correctable varus axis and sufficient flexion in the knee. Contraindications are inflammatory arthropathies and a recent episode of septic arthritis. Relative contraindications are: old age, excess body weight, patellofemoral arthrosis and chondrocalcinosis. A unicompartmental knee prosthesis can be placed via a small parapatellar incision. The postoperative recovery is more rapid than following the classical open approach, while the knee function after 5 years is comparable. The knee function also seems better following a medial unicompartmental knee prosthesis than after valgusising tibial head osteotomy. The latter is still preferred for young active patients. Medial unicompartmental knee prostheses fail in 6-8% of patients. Revision to a total knee prosthesis is then the treatment of choice. In the long term, unicompartmental prostheses with a mobile bearing become loose less often than comparable prostheses with a fixed bearing.

Arthroplasty, Replacement, Knee↗
PubMed2004

[Development and clinical application of the Chinese-made inflatable penile prosthesis].

OBJECTIVE: To study the effect and safety of the Chinese-made inflatable penile prosthesis in the treatment of erectile dysfunction (ED). METHODS: According to the anatomy and physiology of Chinese men, an inflatable penile prosthesis was developed in China, consisting of an innovated pump, a reservoir, and a pair of penile cylinders, which were connected by tubes to form a complete system. It was authorized to be used clinically by State Food and Drug Administration (SFDA). Forty-five cases of organic ED were selected for penile prosthesis implantation. Penoscrotal approach was used to implant the cylinders into the corpus cavernosum, the pump into the scrotum and the reservoir into the prevesical space. RESULTS: Surgical problems and mechanical failures were not found in the subjects. Post-operative complications occurred in 3 cases (6.6%), but did not affect the intercourse. Satisfactory intercourses were achieved 10-12 months later and the intercourse duration averaged about (20 +/- 6) min. CONCLUSION: The Chinese-developed inflatable penile prosthesis was safe and effective for patients with ED, with low rate of mechanical failures. Its long term effect has yet to be further studied.

Adult↗
PubMed2005

[Reimplantation of heart valve prosthesis at the 25th week of gestation].

OBJECTIVE: Pregnancy in a woman with thrombosis of heart valve prosthesis at the 25th week of gestation and fetal death during reimplantation of prosthesis with the use of extracorporeal circulation. SUBJECT: Case report. SETTING: Department of Gynecology and Obstetrics, 2nd Medical Faculty of Charles University, Motol Hospital, Prague. SUBJECT AND METHOD: Patient L. S., 24 years old, first pregnancy, admitted to coronary heart unit at the 25th week of gestation with a blocked heart valve prosthesis, NYHA IV, left heart failure, and pulmonary edema. There was an insufficient anticoagulation therapy during pregnancy and a thrombosis of the prosthetic heart valve was suspected from that reason. Reimplantation of a prosthetic heart valve with the use of extracorporeal circulation was indicated in spite of a possible risk for the fetus. The thrombosis was confirmed during cardio surgical operation and a change of the prosthesis was successfully performed. After the patient was converted to extracorporeal circulation, bradycardia and intrauterine fetal death occurred. With regard to the patient's coagulation and circulatory instability, further management was necessary because of fetal death--termination of pregnancy by minor caesarean section was the only alternative. Six hours later an 850 g weight dead fetus was delivered. There were no serious complications during the postoperative period. CONCLUSION: Reimplantation of a prosthetic heart valve from vital indication was performed at the 25th week of gestation. After conversion of mother to extracorporeal circulation, fetal death occurred. The patients was released with satisfactory cardiopulmonal compensation.

Adult↗
PubMed1992

[An obstruction of a valve prosthesis implanted in the tricuspid position].

Dysfunction of a prosthesis implanted in tricuspid position is a severe complication that may develop with minimal symptoms. A patient who presented clinical manifestations of heart failure for two weeks due to obstruction of a mechanical prosthesis in tricuspid position is described. Fibrinolytic treatment was given unsuccessfully, therefore prosthetic replacement was performed. In the removed prosthesis, a fibrotic pannus which developed in the strut and disc was seen. We review the clinical manifestations, the diagnosis and treatment of the dysfunction of a prosthesis implanted in tricuspid position.

Aortic Valve↗
PubMedDate not supplied

[Intragastric migration of a plastic prosthesis placed for repair of a diaphragmatic perforation. Case report].

CASE: We report the case of a 21-year old female with multiple surgeries. Her problem began after last surgery, which got complicated by a diaphragmatic perforation on the left side so it was necessary to repair the defect with a plastic prosthesis, since that time she complained of abdominal pain. In an abdominal computed axial tomography prosthesis was observed and by endoscopy its presence into stomach was confirmed, because its size and rigidity its endoscopic extraction was impossible, so it was surgically extracted. One and half month after surgery the patient's evolution was satisfactory. DISCUSSION: Migration is one of the most common complications of medical prosthesis placed into abdominal cavity. However precise incidence is unknown, neither intraluminal migration to the gastrointestinal tract. We didn't find previews reports about intragastric migration of a prosthesis that was used to repair a diaphragmatic defect.

Adult↗
PubMed1991

Reconstruction of the anterior cruciate ligament with a Dacron prosthesis.

We repaired the anterior cruciate ligament of the knee using a Dacron prosthesis in fifty-four patients. Nineteen patients had an acute injury of the anterior cruciate ligament, and thirty-five had a chronic rupture. In each patient, only one knee was involved. In twenty-six patients, the prosthesis was implanted arthroscopically, and in twenty-eight, the operation was done by arthrotomy. The length of follow-up ranged from two to five years. In thirty-one patients, a second arthroscopy of the knee was done at follow-up, and the findings were recorded. Only twenty-three patients were free of symptoms at the latest follow-up. Stability and the scores on the grading system of Lysholm and Gillquist were excellent in the first postoperative year; the results worsened due to complications occurring in the second year of follow-up. There were no differences in the results between patients who had a closed procedure and those who had an open procedure. No differences were noted between the patients who had an acute injury and those who had a chronic rupture. Twenty-six failures were directly related to the prosthesis, including rupture of the femoral insertion (thirteen) or tibial insertion (three), rupture of the central body (seven), and elongation in continuity (three). We concluded that a free Dacron prosthesis that is used to replace or supplement a torn anterior cruciate ligament is not a durable substitute for that ligament.

Adolescent↗
PubMed1991

[Experimental study on a new non constrained total shoulder prosthesis].

We designed a new non constrained total shoulder prosthesis and examined it biomechanically. In order to adapt the shoulder prosthesis for the Japanese, fifty skeletal and one hundred radiographs shoulder joints of Japanese were measured. In radiographs we also measured curvature radius of the humeral head and glenoid fossa. We studied force analysis to elucidate the stability of gleno humeral joint using Rigid Body Spring Model. The result on this study indicate that to lengthen the glenoid surface and to make it near the same radius head and glenoid the joint stability will become stable. Our total shoulder prosthesis consist of a cobalt alloy humeral component, a cobalt alloy glenoid component and a high density polyethylene++ outer head put over a small head of humeral component. The glenoid component have two variations. One is for anatomical replacement and its central angle is 78 degrees. The other is for poor function of rotator cuff and its central angle is 110 degrees. The results of biomechanical experiments showed possibility and advantages of our non constrained total shoulder prosthesis being put into clinical practice.

Alloys↗
PubMed1990

[A case report of the reinforcing technique with collared prosthesis for the prosthetic valve endocarditis in mitral position].

A 58-year-old female was admitted to our hospital because of the prosthetic valve endocarditis in mitral position. In the past, this patient was undertaken double valve replacement in mitral and aortic position. Nevertheless, postoperative course was not in stable condition, showing persistent sign of the infection. The appearance of mitral regurgitant murmur and regurgitant signal by colour Doppler cardiography could make sure of the diagnosis for prosthetic valve endocarditis (PVE) in mitral position. The operation for PVE in mitral prosthesis was undertaken as follows. As there was extensive annular infection around the mitral valve, the new mitral prosthesis (Duromedics valve) with the Gore-tex flange, so called collared prosthesis, was revised. The collared prosthesis was implanted in the mitral annulus by using the suture ring of the Duromedics valve as well as possible, furthermore, the Gore-tex flange were sutured in the left atrial wall 2 cm above the mitral ring. Postoperatively, the infection sign and congestive heart failure were completely subsided. This patient has been in very healthy condition these days and restored to the daily life.

Endocarditis, Bacterial↗
PubMed1989

[Malfunction of the Björk-Shiley valve prosthesis due to disc defacement--report of two cases of successful reoperation].

Derlin-disc model Björk-Shiley valve prosthesis was reoperated due to the disc defacement. One had admitted cerebral embolism which was suggested due to the prosthetic valve malfunction of aortic position and the other had congestive heart failure due to the malfunction of mitral position. These patients had implanted Derlin-disc model Björk-Shiley valve prosthesis in the aortic and mitral position 10 and 11 years ago. One's cineangiocardiography showed mild aortic regurgitation and the other showed mitral regurgitation due to the malfunction of the prosthesis. The episode of cerebral embolism in one patient was suggested due to the malfunction of aortic prosthetic valve, and congestive heart failure in the other patient was due to the malfunction of mitral prosthetic valve. These prostheses which removed at the reoperation were observed with strat shape indentation and distinct of the disc which resulted the malfunction of the prostheses. In patient who replaced with Derlin-disc model Björk-Shiley valve prosthesis should be carefully followed up.

Aortic Valve↗
PubMed1989

A metal-backed, rotating-bearing patellar prosthesis to lower contact stress. An 11-year clinical study.

A congruent-contact, metal-backed, rotating-bearing patellar prosthesis has been used clinically over an 11-year period. The features of this implant include a congruent-contact, rotating bearing attached to a thin metallic anchoring plate fixed to the bone by cruciate fixturing fins. The device was initially used with methylmethacrylate and later used as a cementless, porous-coated, ingrowth fixation implant. The benefits of congruent contact with mobility to adjust its tracking position during flexion and extension help to eliminate axial shear stresses at the bone-prosthesis interface and lower the contact stresses at the bearing-metal interface to improve wear properties. Prostheses were implanted in 515 knees over a period of six months to 11 years. Of these 515 knees, 331 patellar prostheses have been followed for 24 to 132 months (mean, 73 months). Of that group of 331 implants, 141 were cemented and 190 were cementless. Specific complications involving the use of this implant were as follows. One intraoperative vertical midpatellar fracture in a cemented case went on to uneventful healing with an excellent result. Two displaced postoperative transverse midpatellar fractures (0.39%) occurred in two revision total knee arthroplasties that involved major lateral releases. One of those was a cemented revision and required removal of the implant and a partial patellectomy to gain an excellent result. In the other, a noncemented revision, the patient lacks 45 degrees of quadriceps extension and has a poor result following traumatic fracture at three years postsurgery. One patellar dislocation (0.19%) occurred in a 270-pound, osteoarthritic man in whom undersized components were used. No polyethylene wear-through, separation from the metal anchoring plate, or implant breakage was seen in this series. Overall, the performance of this congruent-contact, metal-backed, rotating-bearing patellar prosthesis indicates the prosthesis can provide long-term function and stability with few short-term or long-term complications.

Adult↗
PubMed1989

[Cineradiographical significance for diagnosis and treatment of thrombosed Björk-Shiley prosthesis in the aortic position].

In the periods between February 1973 and December 1987, 377 Björk-Shiley valve prostheses have been implanted in the aortic position in our institute. The maximum opening angle of the prosthesis have been cineradiographically measured in 30 cases. The maximum opening angle of the convexo-concave valve having an opening angle of 60 degree (CC 60) was measured as 58.8 +/- 1.9 degree and that of the monostrut valve having an opening angle of 70 degree was 69.4 +/- 2.1 degree. During this period we have experienced 6 cases of thrombosed Björk-Shiley prosthesis. They have shown restriction of the opening from 26 to 58.9 degree and restriction of the closing from 9.2 to 41.8 degree. Thrombolytic treatment was successful in case with thrombosed Björk-Shiley prosthesis which showed restriction of the opening angle on cineradiogram. 4 cases with restriction of the closing angle on cineradiogram were treated operative thrombectomy. Three of them have had uneventful reoperative course in the follow up period of 8 years. We believe that cineradiography is very useful for not only diagnosis but also decision of management for thrombosed Björk-Shiley prosthesis in the aortic position.

Adolescent↗
PubMedDate not supplied

Technical aspects of valvular replacement with the St. Jude prosthesis.

Technical aspects for the implantation of the St. Jude Medical prosthesis are discussed. In our experience with 588 implants, the most important considerations are removal of residual calcium and preparation of annular and subvalvular areas, correct assessment of annular size, selection of proper prosthetic size, and placement of the sutures avoiding the use of pledgets on the ventricular side of the prosthesis. A special valve orientation is not needed in the great majority of patients, but necessary guidelines for individual patients were discussed. Using these technical guidelines, implantation of this prosthesis is simple, results in a low incidence of complications, and avoids damage to the prosthesis during implantation.

Heart Valve Prosthesis↗
PubMedDate not supplied

Valve replacement with the tilting disc Sorin prosthesis in patients with narrow aortic annulus.

The Authors summarize their 5-year experience of the clinical use of the Sorin tilting disc prosthesis in 40 patients (group A) with narrow aortic annulus, compared with a control group (group B: 116 patients) where a larger Sorin prosthesis was implanted. Follow-up lasted from 1 to 60 months, with a mean of 25.6 +/- 12.3 in group A and 20.4 +/- 11.9 in group B. Early and late mortality were low: 1/40 and 2/39 (2.5 and 5.1%) in group A and 4/116 and 9/112 (3.4 and 8.0%) in group B (p = NS): only two deaths, one in each group, were prosthesis-related. Actuarial survival was comparable: 91.2% (CL: 96.3-86.1%) in group A and 78.0% (CL: 87.6-68.4%) in group B, as were probability of being event-free and alive, non-reoperated and with few or no symptoms [group A: 61.7% (CL: 72.4-51.0%) and 77.4% (CL: 85.9-68.9%) respectively; group B: 78.8% (CL: 83.4-74.2%) and 61.1% (CL: 85.9-68.9%) respectively]. The Authors conclude that the Sorin tilting disc prosthesis is a reliable valve substitute in the narrow aortic annulus; they recommend that enlargement procedures should be confined only to patients with annulus size less than 19 mm.

Actuarial Analysis↗
PubMed1986

[Total radiocarpal prosthesis. Preliminary study].

The mechanical requirements before satisfactory muscular balance in a total wrist prosthesis have been studied in 25 cadavers. The centre of rotation was determined in X-Rays; it was localised in the sagittal plane crossing the axis of the forearm and in the frontal plane situated in front of the axis of the forearm. A graphic model of the wrist was then established. A total prosthesis was then designed, made up of two components with a torus surface. This prosthesis was found to be compatible with the wrist model. Movement required forces only slightly greater than normal muscular activity. One male was operated on using this prosthesis. The result was satisfactory after one year.

Adult↗
PubMed1980

[Last result of the first humerus prosthesis out of isoelastics (author's transl)].

The present knowledge about alloarthroplastic is given in a short summary, pointing out the special importance of the isoelastic prosthesis. The importance of a long term observation is pronounced and demonstrated by the first isoelastic shoulder prosthesis implanted 10 1/2 years ago, after resection of a semimalignant caput humerus tumor. During this time no pain, incompatibility, stress protection or loosening of the prosthesis could be observed. The bone reaction during the time of fixation is described. Within 10 1/2 years the mobility of the prosthesis as part of the shoulder joint has decreased, which is probably explained by a shrinking of the shoulder joint capsule.

Female↗
PubMedDate not supplied

Echocardiographic and phonocardiographic characteristics of the Hall-Kaster aortic disc valve prosthesis.

The Hall-Kaster (H-K) valve is a new tilting disc valve prosthesis which has recently been taken in use of heart valve replacement. Simultaneous echo- and phonocardiographic studies were performed in nine patients with a normally functioning H-K prosthesis in the aortic position. The prosthesis is well recorded by a M-mode echocardiogram. The opening and closing of the disc were easily recorded in all cases. The disc itself opened and closed very rapidly, in most cases too rapidly for quantitative assessment. In two cases, mean opening and closing velocity was measured to 38.8 cm/s and 51.8 cm/s, respectively. The opening sound of the prosthesis was rarely identified on the phonocardiogram. The closure of the valve was recorded as a discrete single high frequency sound. Systolic time intervals measured by combined echo- and phonocardiography revealed values for pre-ejection period similar to the predicted values, while the left ventricular ejection time tended to be slightly shorter than expected.

Adult↗
PubMed1982

Improved results for dissecting aneurysms. Intraluminal sutureless prosthesis.

Surgical therapy for dissection of the thoracic aorta has had a high mortality. One contributing factor has been hemorrhage from the prosthesis and the suture lines. A method of treatment with an intraluminal prosthesis that requires no end-to-end anastomosis has been developed. We have used this method in 14 patients, of whom eight had acute thoracic aortic dissections and six had chronic dissections. We assembled our own prosthesis in the first five cases but, more recently, we have utilized an intraluminal prosthesis provided by USCI. Eight of the patients had type 1 dissection, of whom five required concomitant aortic valve replacement and three coronary artery bypass grafting; one had a type II dissection and five had type III dissections. The age range was 31 to 71 years with a mean of 58. There were 12 men and 2 women. There were no intraoperative deaths, but one patient died 10 days postoperatively of a perforated ulcer and another died at 6 months of empyema. Follow-up has been from 9 to 51 months with a mean of 22 months. There has been no evidence of compromise of the aortic lumen and no prosthetic problems, such as erosion, migration, or thrombosis. This technique provides a safe and simple way to repair dissecting aneurysms of the thoracic aorta and has provided long-term reliability. We have subsequently used this graft for 11 patients with aneurysm of the aorta with favorable results. We presently recommend this technique for dissecting, atherosclerotic, and Marfanoid aneurysms of the thoracic aorta.

Adult↗