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The modification of some angles and indices used in radiographic hip measurements have been presented. Idelberger and Frank angles, "hip value", roof-head index, decentration index were discussed. Advantages coming from the use of those modifications have been exposed.
Between 1972 and 1982 34 tumour prostheses (23 total replacements, 11 semitotal replacements) of various designs were implanted at the State Orthopedic Clinic in Munich-Harlaching and at the University Orthopedic Clinic in Grosshadern. The indications were primary and secondary malignant tumours, potentially malignant tumours, peritrochanteric pseudarthroses, and loosening of prostheses where bone conditions were poor. Since 1977 only the "Harlaching" femoral tumour prosthesis, a locally developed model, has been used. Its distinguishing feature is the modular or kit principle, which renders it possible to adapt the prosthesis and define its length accurately during surgery. On the basis of 13 long-term observations, in some cases extending over 8 years, it was established that this tumour prosthesis need not be regarded as merely a palliative intervention (this applies also to younger patients with a longer life expectancy); the slight and transitory complications and the relatively good long-term functional results are encouraging.
The author presents an account of the development of scintigraphic methods in the detection of inflammatory processes of the musculoskeletal system. The original method used in vitro 111In labelled separated leucocytes. It was improved by the possibility to label leucocytes by means of HMPAO 99mTc. In vivo leucocytes can be labelled by means of monoclonal antibodies. Nanocolloid offers similar possibilities as regards use and gives a good yield. Its use is simple and the preparation is available. Scintigraphy with nanocolloid must be considered nowadays the first scintigraphic method used when an inflammatory process is suspected, in particular of the extremities. Scintigraphy with nanocolloid can differentiate in planned revision alloplasty septic and aseptic loosening. The mentioned finding can be used for planning, implementation and ensuring the operation. The author was able, in collaboration with the department of nuclear medicine, to test scintigraphy with nanocolloid in five patients with complains after alloplasty of obscure origin. Patients' data are listed in table a and two cases are discussed in more details.
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Testing orthopaedic implants at the proximal femur of sheep requires knowledge of the contact forces acting on this joint. Telemeterized implants were used for long-term measurements of these forces in four sheep, mostly during treadmill walking. Joint forces in the same sheep varied widely from day to day and interindividual differences were also pronounced. Forces during walking were mostly higher than in previous short-term measurements. At medium walking speed, loads in the range of 65-140% of the body weight were typical. Fast walking increased the forces by only 20%, compared to slow speed. Stomping on the ground at the beginning of the stance phase and starting to run freely led to very high forces. The highest values observed were nearly four times the body weight. As in humans, the directions of high forces varied only slightly in the frontal plane throughout the whole stance phase but much more in the transverse plane. With regard to the force magnitudes and their directions, sheep seem to be a good model for testing human implant at the proximal femur.
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Osteoarthritis of nonknee joints, although less common than knee osteoarthritis, remains a significant and disabling condition for many present and former athletes. These injuries can be caused by repeated loads or following a specific traumatic event. The resulting pain and loss of motion can limit function and ability. Arthroscopic techniques in many cases enable surgeons to symptomatically treat limitations of range of motion and pain, prolonging active careers. Joint replacement remains the ultimate solution for hip osteoarthritis, and may be a viable option in ankle osteoarthritis.
The histological appearance of the implant-bone boundary in eight preparations from seven deceased patients in whom a polyethylene acetabulum socket had been inserted without cement between 3 weeks and 3 years previously is described. In all cases, a good or excellent clinical result had been present up to death. All sockets were firmly anchored macroscopically in the bone of the acetabulum. Three zones were defined in accordance with the mechanical strain on the surface of the cup: (a) zone of compression; (b) zone of transition in which mainly shear forces act; and (c) zone of decompression, which corresponds to the region below the "equator." It was noticeable that a layer of connective tissue separated the implant from the bone over almost the entire surface. This layer was very thin in the region of the pressure transfer layer, and thicker in the decompression zone. At sites at which pressure and shear forces act a fibrocartilaginous tissue was found, and the "subchondral" bone was only occasionally in direct contact with the polyethylene surface. At some sites, but above all in the region of the compression zone, very tiny particles that were birefringent in polarized light were found. Either these derive from very fine grindings from the prosthesis surface or they are to be interpreted as a result of "biodegradation" of the polyethylene. This observation permits the conclusion that the biocompatibility of the implant can be improved further by coating the polyethylene surface.
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Ten coxofemoral joints from 5 dog cadavers were used to study the effect of coxofemoral positioning on passive hip laxity. A material test system was used to measure lateral translation when force was between 20 N of compression and 40 N of distraction. Using the orthogonal coordinate system imposed in this study, neutral position was empirically defined at 15 degrees of extension and 10 degrees of abduction, relative to the plane of the pelvis, and no internal or external rotation of the femur. The hips were mounted in a custom-designed jig that allowed 1 rotational degree of freedom (ie, either flexion/extension, adduction/abduction, or internal/external rotation), while holding the other 2 constant. Lateral translation of the hips was tested at 10 degrees intervals from 30 degrees of flexion to 70 degrees of extension, 40 degrees of adduction to 60 degrees of abduction, and 30 degrees of internal rotation to 40 degrees of external rotation. Lateral displacement was maximal at 10 degrees of extension, 20 degrees of abduction, and 10 degrees of external rotation, approximating the neutral coxofemoral position during stance. As the hips were rotated into extreme positions, the amount of lateral displacement occurring with the same applied load decreased significantly to 32.0 to 65.3% of the maximal displacement. Determining the position of the hip associated with maximal passive laxity in vitro is essential to the design of a precise and accurate clinical stress-radiographic method to quantitate joint laxity in dogs. Our results confirm earlier work that passive hip joint laxity is at a maximum with the hip approximately in a neutral weight-bearing position.