Acta orthopaedica Scandinavica最新文献

{"title":"Hip revision using the Exeter stem, impacted morselized allograft bone and cement: a consecutive 5-year radiostereometric and radiographic study in 15 hips.","authors":"Ewald Ornstein,&nbsp;Herbert Franzén,&nbsp;Ragnar Johnsson,&nbsp;Magnus K Karlsson,&nbsp;Lars Linder,&nbsp;Martin Sundberg","doi":"10.1080/00016470410001385","DOIUrl":"https://doi.org/10.1080/00016470410001385","url":null,"abstract":"<p><strong>Background: </strong>Impaction grafting in hip revision surgery is widely used but studies with mid- and long-term follow-up are scarce.</p><p><strong>Patients, methods and results: </strong>A 5-year radiostereometric (RSA) follow-up of 15 hip revisions with the Exeter stem, morselized impacted allograft bone and cement revealed that 3 stems had not migrated between 2 and 5 years after revision, 11 stems had migrated to a minor degree in at least 1 direction, and 1 stem was loose according to RSA but without any radiographic signs of loosening or pain. The pain score was comparable to primary arthroplasties.</p><p><strong>Interpretation: </strong>From a 5-year perspective, first-time hip revisions for aseptic loosening with impacted morselized allograft bone and cement appear to yield good clinical results, although stem migration continues to a minor degree 2 years after revision.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 5","pages":"533-43"},"PeriodicalIF":0.0,"publicationDate":"2004-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001385","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24786662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contamination of primary total hip replacements in standard and ultra-clean operating theaters detected by the polymerase chain reaction.","authors":"Michael T Clarke,&nbsp;Paul T H Lee,&nbsp;Christopher P Roberts,&nbsp;Jim Gray,&nbsp;Graham S Keene,&nbsp;Neil Rushton","doi":"10.1080/00016470410001394","DOIUrl":"https://doi.org/10.1080/00016470410001394","url":null,"abstract":"<p><strong>Background: </strong>Many organisms that are responsible for low-grade infection after total hip replacement (THR) are not recognized by routine culture.</p><p><strong>Patients and methods: </strong>We examined wound contamination during primary total hip replacement performed in standard and ultra-clean operating theaters. 20 THRs were performed in each type of theater. Paired tissue specimens taken at the beginning and end of surgery were analyzed by bacterial culture and for the presence of bacterial DNA by the polymerase chain reaction (PCR). In total, 160 specimens (80 for culture, 80 for PCR) from 40 THRs were tested.</p><p><strong>Results: </strong>In standard theaters, none of the 20 specimens taken at the start of surgery were positive by culture, but 3 were positive by PCR (15%). Of the 20 specimens taken at the end of surgery, 2 were positive by enriched culture and 9 were positive by PCR. All specimens positive by culture were also positive by PCR. In ultra-clean theaters, none of the 20 specimens taken at the start of surgery were positive by culture, but 2 were positive by PCR. Of the 20 specimens taken at the end of surgery, none were positive by culture, but 6 were positive by PCR. All specimens that were positive by culture were positive by PCR.</p><p><strong>Interpretation: </strong>Wound contamination of primary THR occurs frequently in both standard and ultra-clean operating theaters and contamination is greater at the end of surgery than at the beginning (p=0.04). In this small series, we found no differences in wound contamination between standard and ultra-clean theaters (p=0.1).</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 5","pages":"544-8"},"PeriodicalIF":0.0,"publicationDate":"2004-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001394","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24786663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Periprosthetic tibial bone mineral density changes after total knee arthroplasty: one-year follow-up study of 69 patients.","authors":"Tarja A Soininvaara,&nbsp;Hannu J A Miettinen,&nbsp;Jukka S Jurvelin,&nbsp;Olavi T Suomalainen,&nbsp;Esko M Alhava,&nbsp;Heikki P Kröger","doi":"10.1080/00016470410001493","DOIUrl":"https://doi.org/10.1080/00016470410001493","url":null,"abstract":"<p><strong>Background: </strong>The critical structure supporting the prosthetic components in total knee arthroplasty (TKA) is tibial trabecular bone. The quality of tibial bone can be evaluated by bone mineral density (BMD) measurements.</p><p><strong>Patients and methods: </strong>We prospectively measured changes in BMD in the proximal tibia after cemented TKA in osteoarthrotic knees. 69 patients were scanned by dual-energy X-ray absorptiometry (DXA) within a week after surgery, and after 3, 6 and 12 months.</p><p><strong>Results: </strong>At baseline, the medial region of interest (ROI) BMD was higher in the varus knees than in the valgus aligned knees (p=0.02). The medial metaphyseal ROI showed a decrease in BMD during the follow-up in preoperatively varus knee joints (p<0.001). In preoperatively valgus knees, there was a slight increase in medial compartment BMD which was not significant (p=0.2). Alignment correction in both groups showed bone remodeling giving similar medial and lateral BMD values, suggesting that the bone became equally strong in both compartments of the metaphysis. There was no association between increasing American Knee Society (AKS) scores and bone remodeling.</p><p><strong>Interpretation: </strong>We suggest that this remodeling is caused by postoperative changes in tibial loading. Our results support the clinical importance of recreating proper valgus alignment of the knee joint in the TKA operation, thus possibly providing better conditions for longevity of the tibial component.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 5","pages":"600-5"},"PeriodicalIF":0.0,"publicationDate":"2004-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001493","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24787785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revision shoulder arthroplasty with morselized bone allograft--a case report.","authors":"Christian Anderberg,&nbsp;Abbas Karladani","doi":"10.1080/00016470410001547","DOIUrl":"https://doi.org/10.1080/00016470410001547","url":null,"abstract":"Copyright © Taylor & Francis 2004. ISSN 0001–6470. Printed in Sweden – all rights reserved. Following pseudoarthrosis of a 4-part fracture of the surgical neck of the humerus, a 60-year-old woman had been operated with a Neer II hemiarthroplasty through a deltopectoral approach. At 66 years old, she was referred to the senior author (AHK) because of consistent pain and limited range of motion (ROM) of her right shoulder. The radiographs revealed erosion of the posterior part of the glenoid, but there was no obvious misalignment of the prosthesis, nor any signs of loosening (Figure 1). Poor external rotation (–40°) and limited flexion/abduction (30°) led to the suspicion of poor soft-tissue balancing, with contracture and tightening of the anterior capsule and shortening of the subscapular tendon. To correct this, revision with a total arthroplasty was planned. The problem turned out to be of a different kind.","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 5","pages":"634-7"},"PeriodicalIF":0.0,"publicationDate":"2004-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001547","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24787790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Greater frequency of distraction accelerates bone formation in open-wedge proximal tibial osteotomy with hemicallotasis.","authors":"Hiroshi Mizuta,&nbsp;Eiichi Nakamura,&nbsp;Satoshi Kudo,&nbsp;Takafumi Maeda,&nbsp;Katsumasa Takagi","doi":"10.1080/00016470410001475","DOIUrl":"https://doi.org/10.1080/00016470410001475","url":null,"abstract":"<p><strong>Background: </strong>In chickens, increased distraction frequency stimulates bone formation in distraction osteogenesis.</p><p><strong>Patients and methods: </strong>We investigated the effect of two different distraction frequencies on bone formation in the distracted portion, and on the time of removal of the fixator, in open-wedge osteotomies of the proximal tibia with hemicallotasis (HCO). The study included 20 consecutive patients (20 knees) who underwent HCO for medial osteoarthrosis of the knee. 10 knees were distracted at a rate of 0.25 mm four times a day (the 4-step group); and the other 10 knees were distracted at a rate of 0.125 mm eight times a day (the 8-step group).</p><p><strong>Results: </strong>There were no significant differences in the preoperative FTAs or the correction angles between the two groups. At all intervals until 6 weeks after the completion of distraction, bone mineral density in the distraction gap was significantly higher in the 8-step group than in the 4-step group. The average time in external fixation was 78 (SD 5) days in the 8-step group as compared to 89 (SD 6) days in the 4-step group, a significantly shorter time.</p><p><strong>Interpretation: </strong>Our findings indicate that an increase in the distraction frequency in HCO provides better bone formation, resulting in a shorter external fixation period.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 5","pages":"588-93"},"PeriodicalIF":0.0,"publicationDate":"2004-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001475","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24786047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A miniature and mobile intermittent pneumatic compression device for the prevention of deep-vein thrombosis after joint replacement.","authors":"Peleg Ben-Galim,&nbsp;Ely L Steinberg,&nbsp;Yishai Rosenblatt,&nbsp;Nata Parnes,&nbsp;Aharon Menahem,&nbsp;Ron Arbel","doi":"10.1080/00016470410001466","DOIUrl":"https://doi.org/10.1080/00016470410001466","url":null,"abstract":"<p><p>The WizAir-DVT is a miniature, lightweight (690 g), battery-operated and mobile intermittent pneumatic compression device (ICD), which enables continuous intraoperative use and immediate patient mobilization postoperatively. We compared its efficacy with a commonly used ICD, the Kendall SCD. Peak femoral vein flow velocity was measured in 20 apparently healthy volunteers at rest and with each device: we found no significant differences between them. A second prospective, randomized, clinical trial was used to compare the efficiency of the device in preventing deep venous thrombosis (DVT) after joint replacement in 50 patients (n=25/group). None developed DVT. Doppler ultrasonography revealed no significant differences. The WizAir-DVT antithrombotic compression device is as safe and effective as the Kendall SCD.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 5","pages":"584-7"},"PeriodicalIF":0.0,"publicationDate":"2004-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001466","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24786046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Positive pivot shift after ACL reconstruction predicts later osteoarthrosis: 63 patients followed 5-9 years after surgery.","authors":"Håkan Jonsson,&nbsp;Katrine Riklund-Ahlström,&nbsp;Jonas Lind","doi":"10.1080/00016470410001484","DOIUrl":"https://doi.org/10.1080/00016470410001484","url":null,"abstract":"<p><strong>Background: </strong>Rupture of the anterior cruciate ligament (ACL) may cause osteoarthrosis (OA) and functional impairment. We wanted to find out whether the degree of knee stability obtained after ACL reconstruction correlates with radiographic and clinical outcome.</p><p><strong>Patients and methods: </strong>We examined 63 patients 2 and 5-9 years after anterior cruciate ligament (ACL) reconstruction. Knee stability was assessed 2 years after surgery by recording AP laxity using radiostereometric technique (RSA) and by performing the pivot shift test. Degeneration of the knee joint was evaluated with bone scintigraphy, and radiographically. Functional outcome was assessed with Lysholm score, Tegner activity scale and with the one-leg hop test.</p><p><strong>Results: </strong>Radiographic signs of osteoarthrosis at the most recent follow-up (5-9 years) did not correlate with knee stability. Patients with positive pivot shift test 2 years after surgery showed increased scintigraphic activity of the subchondral bone at the most recent follow-up, and inferior subjective functional outcome 2 years after surgery. Knees having had meniscus resections had more often OA. Radiographical signs of OA were associated with higher scintigraphic uptake in the operated knee relative to the contralateral knee.</p><p><strong>Interpretation: </strong>The ability to obliterate the pivoting by ACL reconstruction appears to be more important than normalizing the AP laxity in order to prevent later OA.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 5","pages":"594-9"},"PeriodicalIF":0.0,"publicationDate":"2004-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001484","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24786048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of vacuum bone cement mixing systems in reducing methylmethacrylate fume exposure: comparison of 7 different mixing devices and handmixing.","authors":"Ulf J Schlegel,&nbsp;Michael Sturm,&nbsp;Volker Ewerbeck,&nbsp;Steffen J Breusch","doi":"10.1080/00016470410001420","DOIUrl":"https://doi.org/10.1080/00016470410001420","url":null,"abstract":"<p><strong>Background: </strong>Polymethylmethacrylate (PMMA) bone cements are mainly used for implant fixation in joint replacement surgery. During cement preparation for application, all staff in the operating theatre are exposed to methylmethacrylate (MMA) fumes, which are known to have toxic side effects.</p><p><strong>Methods and results: </strong>In this study we found that vacuum mixing of bone cement with 7 commercially available mixing devices significantly reduced the emission of MMA vapors in the breathing zone when compared with classic hand mixing in an open bowl. Gas chromatography appears to be more sensitive for detection of MMA fumes than Photo Inonization Detection.</p><p><strong>Interpretation: </strong>According to present knowledge, even repeated mixing of PMMA bone cement during a normal working day does not seem to constitute an increased health risk, particularly if vacuum mixing is implemented.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 5","pages":"559-66"},"PeriodicalIF":0.0,"publicationDate":"2004-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001420","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24786042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pain in arthroscopic knee surgery under local anesthesia.","authors":"Toshiaki Takahashi,&nbsp;Masanobu Tanaka,&nbsp;Masahiko Ikeuchi,&nbsp;Tetsuro Sadahiro,&nbsp;Toshikazu Tani","doi":"10.1080/00016470410001457","DOIUrl":"https://doi.org/10.1080/00016470410001457","url":null,"abstract":"<p><strong>Background: </strong>We evaluated pain during arthroscopic knee surgery performed under local anesthesia, with respect to various types of lesions and specific procedures used.</p><p><strong>Patients and methods: </strong>Arthroscopic surgery was performed on 63 joints (61 patients), with a median age of 49 years. We asked the patients to describe the pain experienced at each step of the procedure, and to compare the level of pain experienced at the time of injection and during the operation, using a visual analog scale (VAS).</p><p><strong>Results: </strong>Pain experienced at the time of injection of the local anesthetic was more severe than the pain experienced during the surgical procedure. Local anesthesia provided good pain control during partial resection of the meniscus, chondroplasty, and removal of free bodies. Patients sometimes experienced more pain during treatment of the suprapatellar pouch, including the plica and the anterior cruciate ligament.</p><p><strong>Interpretation: </strong>Injection of the local anesthetic was usually the most painful phase of the entire procedure. Patients were generally satisfied with the pain control.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 5","pages":"580-3"},"PeriodicalIF":0.0,"publicationDate":"2004-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001457","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24786045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Image-guided surgical simulation--a proven improvement.","authors":"Li Felländer-Tsai,&nbsp;Torsten Wredmark","doi":"10.1080/00016470410001358","DOIUrl":"https://doi.org/10.1080/00016470410001358","url":null,"abstract":"Copyright © Taylor & Francis 2004. ISSN 0001–6470. Printed in Sweden – all rights reserved. Sir—In a paper by W-Dahl et al. (2003), the authors describe rather intricate routines for the care of external fixators. During the last two decades, I and most of my colleagues at three hospitals have used a simple protocol which has also also been taught at several courses on fracture treatment with external fixators. After surgery, the pins (or, rather, screws) are bandaged with small dry sterile gauzes which are left in place for 10–14 days. Then the patient is instructed to wash the wounds with liquid soap and ordinary tap water when he/she takes a daily shower. If the screws require cleaning, this is easily done with a clean new toothbrush and the wounds, screws and external fixator are flushed with the shower. When the skin and wounds have dried (if necessary, with the help of a hair-dryer), small dry gauze bandages are applied around the screws, but circular bandages are not used. The crusts on the skin are left in place. Dry crusts fall off by themselves. There is no use of cotton buds, and no care from a district nurse is required, most patients can manage these daily routines themselves. By using this simple protocol for postoperative care of external fixators, we have reduced the number of “pin” tract infections to a minimum. There is no need of prophylactic antibiotics after the day of surgery. Dry wounds around stable screws do not become infected. A few of our patients carrying external fixators for long time have even omitted bandages altogether, but have practiced daily cleaning as described. The two most common causes of a “pin” tract infection are skin tension around a screw and/or loosening of a screw. Skin tension is treated by a sharp incision, and loose screws should be replaced. According to my personal experience, conical screws are less reliable than e.g. straight apex screws which are safely anchored in both cortices. In the metaphyseal parts of the tibia, a half-ring montage with four screws applied in different directions, thereby locking each other, or an Ilizarov ring is mechanically safer than two parallel screws.","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 5","pages":"511-5"},"PeriodicalIF":0.0,"publicationDate":"2004-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001358","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24786659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}