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At least 1,477 records · Page 82Linked to original sources
PubMed1987

Fatigue fracture of the interlocking nail in the treatment of fractures of the distal part of the femoral shaft.

The clinical and mechanical factors predisposing to a fatigue fracture of an interlocking nail were studied in seven patients who were treated for a fracture of the distal part of the femur. In all patients, the fracture of the femur was five centimeters or less from the more proximal of the two distal screw-holes. Finite-element analysis revealed that the stress on the nail exceeded its fatigue endurance limit and that the femur had to regain 50 per cent of its original stiffness through healing to accommodate weight-bearing without the risk of fatigue failure of the nail. The risk of fatigue failure may be minimized by using nails that have a larger diameter and by avoiding early weight-bearing.

Adolescent↗
PubMed1996

Peritoneal catheter-related complications: a comparison between hemodialysis and intermittent peritoneal dialysis in the break-in period.

We prospectively monitored the clinical outcome of 89 curled, double-cuff peritoneal catheters (PC) implanted by surgeons over one year. Thirty-six cases (40%) were supported with hemodialysis (HD) (group A) and 53 cases (60%) were supported with weekly intermittent peritoneal dialysis (IPD) (small exchange volume with a cycler) (group B) for four weeks before commencing continuous ambulatory peritoneal dialysis (CAPD). PC-related complications between the two groups were compared. Ten cases failed to complete the six-month observation period (8 died, 1 received kidney transplant, and 1 defaulted follow-up),Total experience accumulated was 494 patient-months (195 patient-months in group A, 299 patient-months in group B). The incidence of pericatheter leakage (group A vs group B) was significantly higher in group B (0% vs 13%, p < 0.05). There were no significant differences in the incidence of other PC-related complications, removal of PC, and mortality rate in the two groups. The incidence of pericatheter leakage was significantly higher in diabetic patients (71% vs 22%, p < 0.05), and group B patients with leakage had a higher incidence of external cuff erosion 57% vs 7%, p < 0.005) and delay in CAPD training (71% vs 7%, p < 0.005). We conclude that both HD and IPD are equally safe renal replacement therapies in the break-in period, while patients supported with IPD had a higher incidence of pericatheter leakage, which was associated with other catheter-related morbidities including external cuff erosion and delay in CAPD training.

Adult↗
PubMed2005

Fatigue resistance analysis of tibial baseplate in total knee prosthesis--an in vitro biomechanical study.

BACKGROUND: Tibial baseplates were occasionally reported with clinical fatigue failures. This study postulated that tibial baseplate of a specific mobile bearing design with a uniform thickness across the baseplate offers more fatigue resistance than the fixed-bearing design. Tibial baseplates of a fixed bearing and a mobile bearing design were fatigue-tested in vitro to study their fatigue resistance. METHODS: Five samples of each design were tested under a sinusoidal loading between 90 N and 900 N at 30 Hz till failure or 10 million cycles. Experimental setup followed a standard published test method. Scanning electron microscope was used for inspecting the fracture surface of the failed baseplate. FINDINGS: Two baseplates of fixed bearing design failed before 10 million cycles. Fatigue crack advancement marks were visible on the fractured surface of the failed samples. The fractured cross-section showed that the failure started near the end of the fin, it was likely due to the stress concentration as stress singularity existed at a point of sudden geometrical change. Five mobile bearing baseplates passed the test. Design of the tibial baseplate without fin structure and with a uniform thickness across the whole baseplate could help reducing the incidence of fatigue failure. INTERPRETATION: The prosthesis survival rate was influenced by the long-term integrity of the metallic part of the prostheses such as the tibial baseplate. This study revealed that the tibial baseplate of a mobile bearing design with a uniform thickness provided better fatigue resistance than fixed bearing one. Standardized fatigue screening of the tibial baseplate was considered important in designing knee prostheses.

Biomechanical Phenomena↗
PubMed2003

A new test for bipolar prosthesis disassociation.

Because of several failures by dissociation of a redesigned bipolar prosthesis, a new, dynamic test was developed. This dynamic cam-out test represents a closer simulation of one possible clinical mechanism of bipolar disassociation. The results of dynamic testing are affected by the bipolar design, particularly the locking mechanism that was the problem with the redesigned prosthesis.

Biomechanical Phenomena↗
PubMed1995

Carpentier-Edwards standard porcine bioprosthesis: clinical performance to seventeen years.

BACKGROUND: The role of porcine bioprostheses in cardiac valve replacement has been under review for several years. The literature deals primarily with age as a determinant of durability, as well as the intermediate-term performance of various prostheses. The performance of the Carpentier-Edwards first-generation standard porcine bioprosthesis is presented over the long-term with further documentation on age determinants. METHODS: The "Guidelines for Reporting Morbidity and Mortality After Cardiac Valvular Operations" were used for definitions of valve-related complications, categorization, and statistical methods. The valve-related complications were evaluated in a time-related manner by actuarial life-table techniques. The Lee-Desu statistic test was used for comparison of performance by valve positions and age groups. Hazard function rates were demonstrated for complications and composites. RESULTS: Of the Carpentier-Edwards porcine bioprostheses implanted in 1,195 patients (1,214 operations, 1,315 valves) commencing in 1975 the early mortality was 7.6% (92). The early mortality without concomitant procedures was 6.1% and with 11.7%. The late mortality was 5.3% per patient-year; 4.6% patient-year without and 7.5% per patient-year with concomitant procedures. The valve-related causes of late mortality (131) were thromboembolism (41), antithromboembolic hemorrhage (14), prosthetic valve endocarditis (20), nonstructural dysfunction (12), and structural valve deterioration (44). The valve-related deaths (early, 7; late, 124) were 21.2% of the total 617 total deaths. Reoperation for valve-related complications was performed in 406 patients (4.1% per patient-year), of which 327 were for structural valve deterioration (3.3% per patient-year). Mortality for reoperation was 0.5% per patient-year (49 patients) or 12.1%. Of the 49 deaths, 33 were caused by structural valve deterioration. The linearized occurrence rate for thromboembolism was 1.6% per patient-year (major, 0.9% per patient-year, and minor, 0.7% per patient-year). The fatal thromboembolic rate was 0.4% per patient-year (41), undifferentiated by valve position. The freedom from thromboembolism was 76% at 17 years (p = not significant by valve position) (major, 87%; fatal, 93%). The freedom from prosthetic valve endocarditis was 92% at 17 years (p = not significant by valve position). The freedom from reoperation, at 15 years, was 38%: aortic (AVR), 55%; mitral (MVR), 20%; and multiple valve replacement (MR), 24% (p < 0.05 AVR > MVR, MR). The freedom from structural valve deterioration, at 15 years, was 41%; AVR, 58%; MVR, 21%; MR, 36% (p < 0.05 AVR > MVR, MR). The freedom from structural valve deterioration was greater for advancing age groups (p < 0.05); AVR > or = 70 years 96% at 12 years, and 65 to 69 years 94% at 12 years and 82% at 15 years; MVR > or = 70 years 85% at 12 years, and 65 to 69 years 54% at 12 years. The freedom from valve-related mortality was 73% at 17 years: AVR, 80%; ; MVR, 61%; and MR, 67% (p < 0.05 AVR > MVR, MR). The freedom valve-related residual morbidity was 94% (p = not significant by valve position). CONCLUSIONS: The Carpentier-Edwards standard porcine bioprosthesis continues to provide satisfactory clinical performance to 17 years. Thromboembolism is a more serious problem than structural failure: 92 major thromboembolic events with 41 fatalities compared with 44 fatalities of which 33 occurred with reoperation. The prosthesis is especially recommended for patients more than 65 years of age for AVR and more than 70 years of age for MVR.

Adult↗
PubMed1992

A six-year prosthodontic study of 509 consecutively inserted implants for the treatment of partial edentulism.

A total of 509 consecutive Brånemark TM implants (Nobelpharma AB, Gothenburg, Sweden) were inserted in 146 patients between December 1982 and May 1989, on which 217 fixed partial dentures were planned. The cumulative failure rates after abutment connection were 3.9% and 4.1% for the maxillae and mandible, respectively. The lack of continuous prosthesis stability was limited to 4.1% for the maxillae and 5.4% for the mandible. The average annual marginal bone loss was 0.77 mm (SD = 1.0) and 0.96 mm (SD = 0.9) for the maxillae and mandible, respectively, during the first year and averaged 0.1 mm for the following years. The mode of connection between teeth and implants or the use of porcelain instead of composite resin as occlusal material did not influence the marginal bone height around the implants. Technical complications were most often related to the materials used. The results of a medium-term follow-up encourage the use of the Brånemark osseointegration system in the treatment of partial edentulism.

Adult↗
PubMed2002

Broken wings--common with the Hardinger plug.

We used the Hardinger occluder plug in 51 consecutive total hip arthroplasties. In 34 hips, 1 or more of the 12 polyethylene wings fractured and could be washed out from the canal. As many as 7 wings were loose in 2 arthroplasties. Although numerous wings were broken, no failure occurred in occlusion. The placement of loose wings in the femoral canal was studied by cementing a Charnley prosthesis in a saw-bone prepared with loose wings. The model was cut into slices. We found that the plastic wings could come into contact with both the bone and prosthesis.

Hip Prosthesis↗
PubMed2004

Debate: simultaneous bilateral knee replacements: the outcomes justify its use.

The purpose of this paper is to assess the morbidity, mortality, and clinical outcome of simultaneous bilateral total knee arthroplasty. We reviewed 4100 simultaneous bilateral total knee replacements. The knees were subjected to two Kaplan-Meier survival analyses, with failure equal to revision for aseptic loosening and failure equal to patient death. Complications and Knee Society scores were considered. The average Knee Society knee score was 90 points 3 years postoperatively and 87 points 10 years postoperatively. The complication rates were as follows: deep infection (0.8%), superficial infection (0.3%), cardiac (6 arrhythmia, 5 congestive heart failure, 1 cardiac insufficiency, 3 complete heart block, 2 myocardial infarction and cardiac arrest, and 14 myocardial infarction only) (1.5%), intestinal ileus (0.5%), gastrointestinal ulcer (0.4%), thrombophlebitis (0.9%), cerebrovascular accident (0.3%), and urinary (1 BPH-obstruction, 4 renal failure, 2 transurethral resection of the prostate, 16 urinary tract infection, and 2 urinary retention/incontinence) (1.2%). The 10-year prosthesis survival probability was 98.3%. The 10-year patient survival probability was 78.6%. Twenty-five (1.2%) patients died within the first postoperative year. The patients who died within 1 year postoperatively were older than the rest of the group. Higher age and male gender were factors related to increased mortality. The complication rates and clinical outcomes were similar to unilateral total knee arthroplasty. With regard to death early in the postoperative course, simultaneous bilateral total knee arthroplasty may pose a greater risk to the patient than a unilateral procedure. However, the early deaths may be related to older age at the time of surgery.

Aged↗
PubMed1987

Bateman hemiarthroplasty component disassembly. A report of three cases of high-density polyethylene failure.

Mechanical failures occurred in three Bateman bipolar hemiarthroplasties in two patients. In all three occurrences, the disassembly of the bipolar prosthesis was caused by fracture of the polyethylene liner of the bipolar acetabular component. This caused the 22-mm head of the femoral component to separate and unlock from the acetabular component. Both patients have functional hips after replacement of the acetabular component with a new "self-centering" type. The mechanical design may predispose this bipolar hemiarthroplasty to disassemble.

Adult↗
PubMed2006

Survival of tumor megaprostheses replacements about the knee.

UNLABELLED: Limb salvage surgery is an effective procedure with a low risk of tumor recurrence. In an attempt to define the incidence of implant failure at 2, 5, and 10 years postoperatively, we retrospectively reviewed implant survival in a group (n = 105) of pediatric (< 18 years of age) and adult patients who were treated with distal femoral and/or proximal tibial implants for extremity tumors. Issues regarding the timing of failure, reason for failure, and whether pediatric patients had higher rates of failure were posed as secondary questions. The median followup was 57 months (1-235 months). Thirty-two (32/105, 31%) patients had 42 implant failures. The mean prosthesis Kaplan-Meier survivorship of the index group was 84% at 2 years, 73% at 5 years, and 59% at 10 years. Forty-seven percent of all failures occurred within 2 years postoperatively, and 69% occurred within 5 years postoperatively. Pediatric patients had a higher failure rate than adults (42% versus 24%). Aseptic loosening was the most common reason for failure (n = 18/32; 56%). The incidence of failure in tumor megaprostheses is similar to early published literature and the incidence of these failures is highest within the first 3 years. LEVEL OF EVIDENCE: Therapeutic study, level IV.

Adolescent↗