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[Arthrolysis and arthroplasty of the elbow and knee joints].
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[Fracture with irreducible dislocation of the mandibular condyle, with acrylic prosthesis of the temporomandibular joint; late results].
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NeuFlex metacarpophalangeal prostheses tested in vitro.
This paper describes the testing of three single-piece silicone NeuFlex metacarpophalangeal prostheses in a finger function simulator and describes the resulting modes of prosthesis failure. In all cases, failure was due to imminent fracture of the prosthesis across the pivot of the central hinge section. This result is in contrast with previous in-vitro and in-vivo experience with single-piece silicone Swanson and Sutter metacarpophalangeal prostheses, which both tend to fracture at the junction of the distal stem and the hinge. In comparison with earlier in-vitro simulator tests of the Sutter metacarpophalangeal prosthesis, the NeuFlex prostheses showed a greater longevity before fracture. To date, no other reports of fracture of the NeuFlex metacarpophalangeal prosthesis have been reported, either in vitro or in vivo.
[Revision prosthesis for the hip joint in severe bone loss].
When total hip prostheses loosen after initial implantation and subsequent prosthesis replacement, increasing bone resorption occurs in the bed of the prosthesis. Finally, a very thin cortex remains in the bed of the prosthesis, which no longer provides sufficient mechanical stability. The replacement prosthesis described, which is anchored in the distal medullary canal without cement, provides a bridge over the damaged prosthesis bed and results in a condition of relative mechanical stability. After implantation of the replacement prosthesis, lively proliferation of the bone tissue occurs in the old prosthesis bed, which again replaces the bone loss that had taken place previously. The late results that would permit a final assessment of the procedure are not yet available.
[Restoration of the hip joint by means of prosthesis of the femur head].
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Silicone arthroplasty for hallux rigidus. Implant wear and osteolysis.
Between 1980 and 1985, silicone hemiprostheses were implanted because of hallux rigidus in 58 feet of 43 patients who were followed up after an average of 5 years. The majority were satisfied and had good function without pain. However, the toes had shortened because of implant wear, and there was considerable associated osteolysis.
Long-term experience with total joint prosthetic replacement for the arthritic great toe.
A report on the use of 130 double-stemmed flexible hinge silicone elastomer implants as total joint replacements for the metatarsophalangeal (MTP) joint of the great toe in 98 patients since 1971. Of the total number of patients involved, 11 were men and 87 were women; the average age per joint was 57 years. The report is based on a minimum follow-up of 12 months, an average follow-up of 9.4 years, and a maximum follow-up of 16 years. Seven patients (10 joints) were lost to follow-up. In the 57 patients with osteoarthritis, 81 joints were replaced; in the 30 patients with rheumatoid arthritis, 37 joints were replaced. Five patients were revised from a failed excisional hemiarthroplasty, and four patients (with five joints involved) were revised from a failed silicone implant hemiarthroplasty. Two patients had a surgically arthrodesed MTP joint taken down and revised to a total joint arthroplasty. The results were graded excellent, good, fair, or poor based on relief of pain and cosmesis. The overall results were good. On the basis of these findings, the author concludes that there is a place for total joint prosthetic replacement with this device in the surgical reconstruction of the painful, destroyed MTP joint of the great toe.
Late infection with Bacteroides fragilis in a prosthetic joint.
A late infection caused by Bacteroides fragilis in a prosthesis knee joint is presented. The patient's underlying disease may have predisposed her to this organism.
[Morphological evaluation of joint-crossing expanded PTFE prosthesis (author's transl)].
Ten expanded polytetrafluoroethylene (PTFE) vascular grafts were implanted in dogs crossing the joint, performed as iliofemoral bypass. After 1, 3, 6, and 9 months the grafts were studied by light microscopy, scanning, and transmission electron microscopy. There was a good patency of all straight prostheses. The pre- and postkink areas showed thrombosis leading to stenosis. After 9 months endothelium was spread over all other parts of the luminal surface, including the kink area. Intramurally there was a focal ingrowth of fibroblastic cells with the characteristics of myocytes.
Alternatives to hip, knee, and ankle total joint arthroplasty.
Although total joint arthroplasty is the most commonly performed procedure for the treatment of advanced stages of degenerative joint diseases, alternatives to joint replacement remain essential to the armamentarium of the clinician. For the hip, knee, and ankle, alternatives such as synovectomy, osteotomy, and fusion should be considered when contraindications to joint replacement exist. The indications and results of these procedures are discussed as reflected by a review of the recent literature.
Evaluation of joint prostheses and orthopedic appliances.
Several recent articles describe imaging evaluation after joint replacement surgery. The following articles about total hip and knee replacement and silicone rubber prostheses are highlighted because they offer new observations or review typical problems after joint revision surgery.
Differential bone-scanning in the evaluation of a painful total joint replacement.
In an attempt to differentiate between loose and infected total joint replacements, seventy-nine patients were studied with both technetium-99 pyrophosphate and gallium-67 citrate bone scans. Seventy of these patients had positive technetium scans. Nineteen had positive gallium scans and all nineteen had positive cultures at the time of operation, while one patient had a false-negative gallium scan. Ten other patients who had negative technetium-99 scans and a painful total joint were followed without operative intervention. Of these, only two required operation after their technetium-99 scans became positive. Based on these studies, gallium-67 citrate scans combined with technetium-99 pyrophosphate scans are believed to be useful in differentiating between loose and infected prostheses. A negative technetium scan should weigh heavily against surgical exploration in an attempt to find the source of pain.
The mechanical testing of a sliding meniscus knee prosthesis.
A 3-component sliding meniscus knee prosthesis was tested mechanically to evaluate the direct loads and the anteroposterior and mediolateral bending moments on the prosthetic components during the loading phase on a pendulum prosthesis testing machine. The bending moments changed with variation of the component positions. Tilting the tibial plateau produced the greatest change in lateral bending moment on the femoral component but alteration in plateau rotation or femoral tilting produced little change in the low values of the 2 bending moments. It is necessary to ensure that the tibial component is positioned horizontally on the tibial plateau, but it is not necessary to be concerned about the angle of the femoral component to the vertical or the misalignment rotationally of the tibial component. The load ideally passes through the condylar component to the tibia much more centrally than if it were a constrained prosthesis system during the loading range, reducing the likelihood of displacement of the 2 fixed components.
Efficacy of teicoplanin and autoradiographic diffusion pattern of [14C]teicoplanin in experimental Staphylococcus aureus infection of joint prostheses.
Prosthesis infections are difficult to cure. Infection with methicillin-resistant staphylococci is becoming more common in patients with orthopedic implants. Using a recently developed model of methicillin-resistant Staphylococcus aureus (MRSA) infection of a knee prosthesis, we compared the efficacies of teicoplanin and vancomycin. [14C]teicoplanin diffusion in this model was also studied by autoradiography. A partial knee replacement was performed with a silicone implant fitting into the intramedullary canal of the tibia, and 10(7) CFU of MRSA was injected into the knee. Treatment with teicoplanin or vancomycin (20 or 60 mg/kg of body weight, respectively, given intramuscularly twice daily) was started 7 days after inoculation and was continued for 7 days. The teicoplanin and vancomycin MICs for MRSA were 1 microg/ml. Mean peak and trough levels in serum were 39.1 and 23.5 microg/ml, respectively, for teicoplanin and 34.4 and 18.5 microg/ml, respectively, for vancomycin. Fifteen days after the end of therapy, the animals were killed and their tibias were removed, pulverized, and quantitatively cultured. Teicoplanin and vancomycin significantly reduced (P < 0. 05) the bacterial density (2.7 +/- 1.3 and 3.3 +/- 1.6 log10 CFU/g of bone, respectively) compared to those for the controls (5.04 +/- 1.4 log10 CFU/g of bone). The bacterial covents of teicoplanin- and vancomycin-treated rabbits were comparable. The [14C]teicoplanin autoradiographic diffusion patterns in rabbits with prostheses, two of which were uninfected and two of which were infected, were studied 15 days after inoculation. Sixty minutes after the end of an infusion of 250 microCi of [14C]teicoplanin, autoradiography showed that in the infected animals, the highest levels of radioactivity were located around the prosthesis and in the periosteum, bone marrow, and trabecular bone. Radioactivity was less intense in epiphyseal disk cartilage, femoral cartilage, articular ligaments, and muscles and was weak in compact bone. A similar distribution pattern was seen in uninfected rabbits. Thus, teicoplanin may represent an effective alternative therapy for the treatment of these infections.
Prosthetic procedures of the joints of the ankle and foot.
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[Notes on the history of arthroplasty (author's transl)].
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[Contraindications regarding total prosthesis of the hip joint].
The authors have made an analysis of unsatisfactory remote results in 83 (21.5%) out of 387 patients operated for endoprosthezing of the hip joint which resulted from shaking loose the endoprostheses in the bone tissue. A conclusion is made that the following factors may be considered as contraindications to endoprosthesis of the hip joints: coxarthrosis against the background of arthroso-arthritis, neglected stages of protrusive coxarthrites, deforming osteoarthrosis due to the use of corticosteroids, pronounced senile osteoporosis.