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At least 1,243 records · Page 69Linked to original sources
PubMed1993

The results of cardiac valve procedures.

Valvular procedures have become increasingly safe and efficacious. The number of procedures and prostheses that are available increases each year. However, a precise comparison of alternative treatments for patients with valvular heart disease requires an accurate and unbiased recording of the results. The American Association for Thoracic Surgery and the Society of Thoracic Surgeons have developed guidelines that are intended to permit a comparison of alternative procedures and prostheses employed in the treatment of patients with valvular heart disease. These guidelines have been followed by most recent reports and have greatly facilitated the comparison of alternative treatment strategies. Reports evaluating the long-term effects of valvular heart surgery should carefully state the population from which the sample was taken, the adequacy of the follow-up, and the closing interval employed. Every attempt should be made to document the causes of death or other adverse events, because if they are not adequately documented they must be assumed to be valve related. Recent studies have demonstrated that age was the major predictor of structural valve failure at 10 years after bioprosthetic implantation. To avoid bioprosthetic failure some surgeons have employed a stentless porcine aortic valve or a homograft prosthesis. Both of these approaches will require the test of time. To compare alternative treatments, definitions and reporting techniques must be uniform. The guidelines have been adopted by most authors reporting the long-term results of valve procedures.

Bioprosthesis↗
PubMed2003

The results of endoprosthetic replacement for tumours of the distal humerus.

Ten patients underwent endoprosthetic replacement of the distal humerus for bone tumours over a period of 30 years. There were eight primary and two secondary tumours in four men and six women with a mean age of 47.5 years (15 to 76). The mean follow-up was eight years (9 months to 31 years). Four patients required further surgery, three having revision for aseptic loosening; two of these and one other later needing a rebushing. There were no cases of postoperative nerve palsy, infection, local recurrence or mechanical failure of the implant. Four patients died from their disease, all with the prosthesis functioning satisfactorily. At follow-up the mean flexion deformity of the elbow was 15 degrees (0 to 35) and the mean range of lexion was 115 degrees (110 to 135). The functional results showed a mean Toronto extremity salvage score of 73% of normal. Endoprosthetic replacement of the distal humerus and elbow is a satisfactory method of treating these rare tumours.

Adolescent↗
PubMedDate not supplied

Osteonecrosis secondary to internal fixation.

Allergies to metals as a cause of failure of joint prostheses has historically been a controversial issue. Loosening of a prosthesis may be due to trauma, infection of the surrounding area, or a faulty implantation of the device. However, cases of loosening of the device do occur without any history of the above criteria. This leads one to consider other explanations for this phenomenon, such as sensitivity of the tissues to one of the metals in the implant. The following presentation demonstrates that metal allergies are a surgical concern when considering joint prostheses, or internal fixation.

Adolescent↗
PubMed1992

Long-term results and survivorship analysis of 89 total condylar knee prostheses.

The results of 89 total condylar I prostheses were assessed using both the Hospital for Special Surgery rating system and survivorship analysis. At an average follow-up period of 9.5 years (range, 5-15) 61 patients (72 knees) were available for clinical and radiographic evaluation. Thirty (41.5%) knees were rated as excellent, 29 (40.5%) good, 4 (5.5%) fair, and 6 (8.5%) poor. Three (4%) cases were considered failures because they needed a second operation. Loss of the postoperative alignment often associated with lateral instability was observed in 23 knees. Loosening of the tibial plateau occurred in two knees; in one of these a successful revision was performed. Survivorship analysis, using deep infection and aseptic loosening as end-point criteria, gave a 15-year probability of survival of 95%. These results confirm the validity of the total condylar prosthesis and the reliability of cementation in knee arthroplasty.

Actuarial Analysis↗
PubMedDate not supplied

[Replacement of the hip joint in young patients under 40 years of age. Clinico-statistical report of experiences].

At Orthopedic Department of Homburg/Saar University Clinic there were - between 1974 and 1985 - altogether 270 cementless total hip replacements by AUTOPHOR-arthroplasty in 243 patients, who were 40 years of age and younger at time of operation. The male patients mostly suffered from posttraumatic joint destructions or idiopathic femoral head necrosis, the female patients from dysplasia coxarthritis. In 43.3% there were previous hip operations in the past. 6 septic failures (5 times removal of prosthesis); 33 (12.2%) aseptic failures, mostly of the femoral component with following exchange operation. Clinical and roentgenological control of 170 cases (septic and aseptic failures excluded). Subjectively good and very good results in 82.3%. Evaluation of clinical datas acc. to the scheme of Merle d'Aubigné. Improvement of preoperative situation (5.4 points average) to 14.7 points average postoperatively. In most of the patients, a professional and social integration could be achieved; only 28 patients received a pension. With regards to the functional inferior alternatives of resection hip rsp. hip arthrodesis, THR by cementless prostheses in young patients with severe joint destructions seems to be justifiable and recommendable - according to our medium-term results.

Adolescent↗
PubMed2006

[Examination of granuloma of revised cemented or cementless total hip arthroplasties using inductively coupled plasma atomic emission spectrometry (ICP-OES)].

INTRODUCTION: Aseptic loosening is the most common problem in total hip arthroplasty (THA). One main aspect is inflammatory reaction against wear particles of the prosthesis materials. Analysing failure mechanisms in THA analysis of the particles and their element distribution of revised granulomatous tissue is essential to improve materials used in THA. MATERIALS AND METHODS: 23 granulomas of revised THA due to aseptic loosening, 13 of which with metal on metal bearing (M/M), were analysed using inductively coupled plasma atomic emission spectrometry (ICP-OES). RESULTS: Elements Cr, Mn, Ni, Al, Cu, Zn, Cd, Ti, V, Zr, Nb and Fe could be detected. The maximum value of Cr was 23.88 ppb (parts per billion), Al 191.02 ppb, Ni 64.95 ppb and Zr 9.96 ppb. The highest value of Al could be found in cementless implants. The maximum value of the elements Cr and Ni could be detected in M/M. In cemented implants the highest value of Zr was found. DISCUSSION: The origin of Zr was the used bone cement in cemented THA. The elements Cr and Ni were significantly higher in M/M bearings. The highest value of Al was detected in granulomas of revised corund rough blasted cementless implants. The histopathologic findings of the revised M/M bearings have been published recently. Inductively Coupled Plasma Atomic Emission Spectrometry (ICP-OES) could not show any differences of the alloying constituents in cases with or without allergic reactions. ICP-OES analysis seems to be not useful examination of histologic sections using SEM with cryotransfer unit.

Arthroplasty, Replacement, Hip↗
PubMed1994

[Failure of the treatment of eventrations and hernias with the PTFE plate (111 cases)].

Patch repair using a PTFE prosthesis was performed in 111 patients over a 5-year period for treatment of incisional hernias (64 cases), inguinal hernias (41 cases, including 29 recurrences), umbilical hernias (4 cases), epigastric hernias (2 cases), lumbar hernias (1 case) and abdominal wall defects after resection for endometriosis (2 cases). The surgical technique was limited to simple patch closure of peritoneomuscular defects without myoplasty. Follow-up was evaluable for every patient and 84 cases have been reviewed clinically by 2 surgeons. 83 patients (86 patches) were followed for at least 1 year (74.8%). Post operative mortality was nil. Morbidity was 17.5% (20 cases, including 14 hematomas, 2 intraperitoneal bleedings, 3 cases of local sepsis, 1 hydrocele). Recurrence rate was 42.2% for incisional hernia repair (27 cases) and 14.6% after inguinal hernia repair. Three out of 4 umbilical hernias and 1 out of 2 epigastric hernias recurred. 14 patients underwent reoperation for recurrent hernia (11 incisional and 3 inguinal). Absence of fibrotic reaction around the PTFE prosthesis was noted in every case and appeared to be the main factor of recurrence. Our experience suggests that patch technique with PTFE prosthesis should be abandoned for the repair of abdominal wall defects.

Adult↗
PubMed2005

Souter-Strathclyde total elbow arthroplasty in rheumatoid arthritis: medium-term results.

We present the outcome of 47 Souter-Strathclyde replacements of the elbow with a mean follow-up of 82 months (12 to 129). The clinical results were assessed using a condition-specific outcome measure. The mean total score (maximum 100) before the operation was 47.21 and improved to 79.92 (p < 0.001). The mean pain score (maximum 50) improved from 21.41 to 46.70 (p < 0.001) and the mean functional component of the score (maximum 30) from 11.19 to 18.65 (p < 0.001). There was negligible change in the score for the range of movement although a significant improvement in mean flexion from 124 degrees to 136 degrees was noted (p < 0.001). Revision surgery was required in four patients, for dislocation, wound dehiscence and early infection in one, late infection in two and aseptic loosening in one. The cumulative survival was 75% at nine years for all causes of failure and 97% at ten years for aseptic loosening alone. Our study demonstrates the value of the Souter-Strathclyde total elbow arthroplasty in providing relief from pain and functional improvement in rheumatoid patients.

Adult↗
PubMed1992

Reoperations on cardiac valves.

As the number of patients undergoing cardiac valve replacement has grown, valve reoperations have become increasingly frequent. The newer generations of mechanical valves are far more efficient and freer from structural failure than the older ones. However, other valve and non-valve related complications still constitute a major cause of morbidity and mortality. On the other hand, bioprostheses, implanted in large numbers in the 1970's and early 1980's, have now gone into the second decade of life since implantation, when biodegradation becomes more frequent. Reoperations are technically more demanding than the original valve procedures because of the mediastinal and pericardial adhesions and the condition of the anulus after removal of the previous prosthesis. Greater awareness of the most dangerous steps and refinements to surgical technique have contributed to the decreased mortality observed in recent years. The risk is higher in certain conditions, such as the presence of prosthetic valve endocarditis and the patient being operated on an emergency basis in NYHA functional class IV. It may also be increased in females and the elderly. Multiple reoperations also carry a higher risk in most surgeon's experience. However, elective reoperations for defective mechanical valves and for replacement of a previously repaired mitral valve carry similar mortality rates to primary valve replacement procedures. The global mortality rates have not been significantly higher in the hands of experienced surgeons working in centers where reoperations are performed frequently. In smaller series high mortality rates are a constant, which underscores the importance of the learning curve. The indications for reoperation must therefore consider all risk factors and, when possible, the procedure must be performed by those who have the most experience. Under these circumstances, elective re-replacement of degenerating bioprostheses and of defective mechanical valves in asymptomatic patients may be advisable.

Bioprosthesis↗
PubMed1995

[Supra-annular mitral valve replacement for a patient with prosthetic valve endocarditis].

Supraanular mitral valve replacement with a 29 mm CarboMedics prosthetic valve was performed for a 58-year-old patient of prosthetic valve endocarditis. He has received mitral valve replacement 2 years ago, and was admitted because of high fever and severe heart failure diagnosed mitral regurgitation due to valve dehiscence. An annular abscess was observed and the new 29 mm CarboMedics prosthetic valve was sutured to the left atrial wall approximately 10 mm above the original annulus in order to secure the firm suturings for valve implantation and to left the infected annulus intact. The patient, however, underwent reoperation because of valve dehiscence from atrial wall 6 months after surgery. Infectious abscess at the native mitral annulau was observed to be completely cured, and a mitral prosthesis was implanted at the annulus. The patient is discharged under satisfactory condition.

Endocarditis↗
PubMed1995

[Isolated stem fracture in total hip replacement].

Clinical, mechanical and metallographic assessment of the isolated fatigue fracture of the Weller stem has been presented. Excessive body weight, too short a stem for the length of the femur and material defects contributed to the failure.

Aged↗
PubMed1998

Jumbo cups and morsalized graft.

Revision of failed acetabular components presents a formidable problem due to associated loss of bone and sclerosis of the remaining bone. Uncemented acetabular components with porous surfaces have revolutionized acetabular revision surgery. They can be stabilized into the existing host bone with supplemental screws even in the face of major bone loss. Nonstructural particulate bone grafts can then be used to supplement the bone stock. With large defects, jumbo acetabular components ranging in sizes from 70 to 80 millimeter outer diameters can be stabilized on the acetabular rim while the defects can be grafted with morsalized bone. Nineteen of such revisions performed for major bone loss without pelvic discontinuity between February 1986 and December 1988 were evaluated at a mean follow-up period of ten years (range eight to eleven years). One component had been revised for sepsis. None of the others had been revised. Definite radiographic failure of fixation of the acetabular component was not seen on any of the other hips. These results strongly support the use of jumbo uncemented acetabular components with morsalized bone grafts even in the face of major acetabular bone loss.

Acetabulum↗
PubMed2006

Dislocation of the hip after reimplantation for infection: an analysis of risk factors.

Dislocation is a well documented complication after a two-stage revision arthroplasty for a deep periprosthetic hip infection. We are aware of no reports specifically evaluating the risk factors for dislocation after reimplantation for infection. We hypothesized greater age, increase in the number of operations on the hip, increase in the length of time from resection to reimplantation, greater limb length discrepancy, smaller femoral offset, and using smaller femoral heads would increase the risk of dislocation. We retrospectively reviewed 34 patients who had a two-stage hip revision for periprosthetic infection with a minimum followup of 2 years. Risk factors for dislocation were evaluated. We compared the rate of dislocation in this group to those patients having revision for aseptic failure. Sixteen dislocations occurred in five (14.7%) of 34 patients. Dislocation occurred in three (1.7%) of 171 patients having revision for aseptic failure. In this small series, age at reimplantation, number of previous operations on the hip, length of time from resection to reimplantation, limb length discrepancy, femoral offset, and femoral head size did not seem to be risk factors for dislocation.

Age Distribution↗