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PubMed1982

[Testing of cementless stepped-stem prosthetic devices replacing the hip shoulder joint of the dog. Comparison of two animal models (author's transl)].

In 6 dogs the hip joint was experimentally replaced using a ceramic stepped-stem prosthetic device implanted in the thigh bone. In six other dogs V4A steel stepped-stem prosthetic devices inserted in the arm bone was used for replacing shoulder joint. The six devices replacing the shoulder joint healed up without complications and proved to be mechanically stable. From six devices replacing the hip joint only one was successful; the remaining five implants did not heal up due to fractures of the stem, loosening in the thigh bone and osteomyelitis. We suggest that these different results are based not on the different material, but on the different conditions characteristic for each implantation sites. The devices implanted in the arm bone of the dog, corresponding to the conditions in man, were stressed mainly by pressure and pull. In such conditions the newly formed bone tissue anchoring in the steps on the stem stabilized the device. On the other hand, the biomechanical load on the hip joint replacing device in the dog is represented mainly by rotation at stress, for which the devices are not conceived. The stepped profile of the stem can not work; it twists in the thigh bone and remains unstable causing consequences such as fractures, osteomyelitis and loosening. For experimental testing of bone and joint replacing prosthetic devices of cementless anchoring systems replacing human hip joint and thigh bone we recommend the shoulder joint of the dog instead of hip joint, because of the comparable biomechanics.

Animals↗
PubMed1999

Total temporomandibular joint replacement. Who? What? When? Where?

The temporomandibular joint, like other joints such as the hip and knee, can be affected by a number of conditions that may lead to joint failure, necessitating total joint replacement. The TMJ Implants, Inc., or Christensen alloplastic reconstruction prostheses, play an important role in the treatment of these conditions. Patients with severely degenerated and/or nonfunctioning joints who undergo reconstruction with the Christensen total joint replacement prosthesis experience an increase in quality of life similar to that experienced by orthopedic patients with total joint replacement of the knee or hip.

Adult↗
PubMedDate not supplied

Lymphadenopathy secondary to silicone hand joint prostheses.

The occurrence of lymphadenopathies was investigated in 23 patients with diverse rheumatic conditions who had silastic prosthesis in joints of the hands, to determine whether these adenopathies were due to the presence of silicone particles. Five cases had clinically detectable lymph node enlargement and tissue samples were studied by light and scanning electron microscopy (SEM) and energy dispersive X-ray analysis (EDXA). In 3 out of the 5 cases foreign body granulomas were observed by light microscopy, SEM showing a highly irregular distribution of foreign body material with a peak for silicone by EDXA. Foreign body particle distribution closely correlated with silicone concentration. No granulomas were found in the two remaining patients with adenopathies who presented a non-specific reactive lymphadenitis. Our findings show that silicone lymphadenopathy is a more frequent complication (13%) of silastic arthroplasty than is usually recognized and therefore should be considered in the differential diagnosis of patients with lymph node enlargement who have previously received a silicone arthroplasty.

Adult↗
PubMed2003

[Treatment of degenerative disease of knee joint with the Oxford prosthesis].

Eleven patients with single compartment arthrosis of the knee were treated surgically, using the Oxford prosthesis. The age of the patients at the time of surgery ranged from 48 to 73 years. Varus deformity of the knee before surgery ranged from 0-23 degrees (average: 11 degrees). Patients with arthrosis of the medial compartment were elected for surgery. Surgery was performed only when passive correction of the varus deformity was possible and when the cruciate ligaments were intact. In all cases surgery yielded a stable knee joint.

Aged↗
PubMed1999

Instability of the elbow treated with semiconstrained total elbow arthroplasty.

The results of nineteen semiconstrained modified Coonrad-Morrey total elbow arthroplasties performed in nineteen patients to treat instability were evaluated at an average of seventy-two months (range, twenty-five to 128 months) postoperatively. Preoperatively, all patients had either a flail elbow or gross instability of the elbow that prevented useful function of the extremity. The instability of sixteen elbows was the result of a traumatic injury or of the treatment of such an injury. The most recent result was satisfactory for sixteen elbows and unsatisfactory for three. The average overall Mayo elbow performance score increased from 44 points preoperatively to 86 points postoperatively. At the most recent follow-up examination, no elbow was unstable. The average arc of flexion was from 25 degrees (range, 0 to 60 degrees) to 128 degrees (range, 30 to 142 degrees), which represented a 58-degree increase from the preoperative average arc. Sixteen patients had little or no pain after the arthroplasty. There were four complications in four patients. Three complications (loosening of the humeral component in one patient and a fracture of the ulnar component in two) occurred postoperatively; all three were treated with a revision procedure. The other complication (a fracture of the olecranon) occurred intraoperatively and was treated with tension-band fixation; the most recent outcome was not affected. Radiographically, one patient had complete (type-V) radiolucency about the humeral component. None of the nine patients for whom true anteroposterior radiographs were available had evidence of wear of the bushings. The bone graft behind the anterior flange of the humeral prosthesis was mature in fourteen elbows, incomplete in two, and resorbed in two. One patient was excluded from this analysis because radiographs were not available. Instability of the elbow resulting in the inability to use the extremity is a challenging clinical situation. However, in patients who are more than sixty years old and in selected patients who are less than sixty years old but who have extensive loss of bone as a result of severe injury, have had multiple operations, or have rheumatoid arthritis, total elbow arthroplasty with a linked, semiconstrained prosthesis reestablishes a mobile, stable joint without premature loosening or failure of the components. In our experience, the use of customized implants, maintenance of the muscular attachments to the epicondyles, and reconstruction of the epicondyles to the implant were unnecessary.

Arthroplasty, Replacement↗
PubMed1989

[Myoplasty in total prosthesis of the hip joint].

When the hip joint is replaced by an artificial one, not infrequently a cavity is formed round the neck of the endoprosthesis which is impossible to be covered with local tissues. It is possible to eliminate such a cavity and prevent the formation of a hematoma by myoplasty. Taking into consideration the peculiarities of vascularization and topography of the muscles situated near the hip joint, several versions of myoplasty of the cavity have been worked out which are used in accordance with its size and localization in relation to the neck of endoprosthesis. Evacuation of the hematoma took place in 3 cases of the total number of 97 operations employing myoplasty, while it was performed in 13 cases of 190 operations without myoplasty. Therefore myoplasty involving musculus gluteus minimus, musculus gluteus medius, musculus rectus femoris and musculus vastus externus, with regard to the size and the localization of the cavity is reliable means of preventing hematoma in case of cavity formation near the neck of the endoprosthesis after the implantation of an artificial hip joint.

Hematoma↗
PubMed1990

Niebauer trapeziometacarpal arthroplasty.

A retrospective review of 22 Niebauer implant arthroplasties of the trapeziometacarpal joint for treatment of advanced osteoarthritis in 18 patients is reported. Mean follow-up was 2.4 years. Thirteen patients stated they had good pain relief, two were slightly improved, and three had no improvement. Six patients believed their functional status was improved, 10 were the same, and 2 were made worse. Thumb abduction and strength measurements were similar in the hands with operation and those without operation. Full opposition was present in 68% of thumbs with operation versus 93% of those thumbs without operation. Asymptomatic implant subluxation of 50% or less was present in 23% of thumbs. However, only 9% had symptomatic mechanical instability and these thumbs showed greater than 75% subluxation. Implant breakage and "silicone synovitis" was not evident on clinical and radiographic examination. Evaluation of the bony response around the implant stem revealed a consistently present sclerotic line. Although the design features of the Niebauer implant offer theoretical advantages for stability and fixation, this study does not demonstrate better results compared with other types of silicone trapezium implants. Therefore, a surgeon should choose this implant on the basis of a personal preference for ease of implantation and not for improved clinical results.

Adult↗
PubMed1992

[Experience with modular system tumor prostheses].

Authors elaborated a modular tumor prosthesis by the use of which the bone segment lost after the resection of hip, femur, knee and proximal tibial tumors can be supplemented in the desired measure. The components of the prosthesis set and the field of its use are described. In the last one and half year modular tumor prostheses were inserted in 10 patients: in 6 primary bone tumors and 4 solitary metastases. One shoulder, 5 hip, 3 stiff knee and 1 tibia diaphysis supplementing modular prostheses were inserted. In spite of 2 complications the initial experiences are encouraging, and in adequate indication the possibility of retaining limb and articular function beside good functional results is given.

Bone Neoplasms↗
PubMed1996

[Status of the endoprosthesis in rheumatic metacarpophalangeal joints. Long-term results of metacarpophalangeal prostheses using Swanson's silastic spacers].

Advanced rheumatoid destruction of the metacarpophalangeal joints frequently requires implant arthroplasty. Among many different types of implants, the Swanson-Silastic-spacer is widely used. The long-term results of 102 arthroplasties of the metacarpophalangeal joint were assessed in 28 rheumatoid patients (34 hands) 10.1 years postoperatively on the average. Marked relief of pain was found in all patients. 75% of the patients reported functional improvement of the hand. Active range of motion decreased from 42 degrees preoperatively to 36 degrees postoperatively on the average. Ulnar drift was corrected from an average of 34 degrees preoperatively to 12 degrees postoperatively. The average extension deficit had improved from 33 degrees at surgery to 11 degrees at the time of follow-up. Grip strength remained unchanged. The radiographical findings showed surrounding osteolysis in 89.4% of the implants and 27.5% broken spacers. In comparison to other types of finger implants, Silastic-spacers showed similarly limited all over results, however, there seem to be less problems in salvage procedures.

Activities of Daily Living↗
PubMed1998

Dental devices; effective date of requirement for premarket approval; temporomandibular joint prostheses--FDA. Final rule.

The Food and Drug Administration (FDA) is issuing a final rule to require the filing of a premarket approval application (PMA) or a notice of completion of a product development protocol (PDP) for certain devices, namely, the total temporomandibular joint (TMJ) prosthesis, the glenoid fossa prosthesis, the mandibular condyle prosthesis (for permanent reconstruction), and the interarticular disc prosthesis. At a later date, FDA will propose reclassifying from class III into class II the generic type of temporary mandibular condyle prosthesis intended for temporary reconstruction following surgical ablation of malignant and benign tumors. This action establishing the effective date of the premarket approval requirement for certain devices is being taken under the Federal Food, Drug, and Cosmetic Act (the act), as amended by the Medical Device Amendments of 1976 (the 1976 amendments), the Safe Medical Devices Act of 1990 (the SMDA), and the FDA Modernization Act of 1997 (FDAMA).

Device Approval↗
PubMed1977

Conformity in condylar replacement knee prosthesis.

Experiments were carried out to determine the optimum conformity between the femoral and tibial condyles in condylar replacement knee prostheses. Wear tests and observations from removed prostheses indicated that both high and low conformity produced characteristic abrasion and fatigue. Partly conforming condyles provided stability under load-bearing but allowed laxity to occur. Fixation to resist the various forces on the tibial components was enhanced by a short central intramedullary peg. Partial conformity is proposed as the optimum configuration between femoral and tibial components.

Biomechanical Phenomena↗
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↗