Acta orthopaedica
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Fossa piriformis is considered the correct point of entry for a straight femoral nail. A trochanteric overhang may make the access to fossa piriformis difficult. We investigated the anatomy of the trochanteric region, paying special attention to the entry point for antegrade intramedullary femoral nailing. ⋯ The anatomic variations of the trochanteric sometimes make it difficult to identify the correct entry point for an intramedullary nail.
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Poor bone stock in patients with osteonecrosis of the femoral head may be a reason for poor outcome after hip replacement. One way of studying bone quality is to measure implant migration. We thus investigated the clinical and radiographic results of cementless THR in younger patients with femoral head osteonecrosis. ⋯ Our findings for porous-coated stems in patients with femoral osteonecrosis indicate no greater risk of stem subsidence and rate of osteolysis after an average of 7 years follow-up. Thus, we continue to use uncemented stems in younger patients with femoral osteonecrosis. However, continued follow-up will be necessary to evaluate the long-term outcome.
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Comparative Study
Exposure to chromium, cobalt and molybdenum from metal-on-metal total hip replacement and hip resurfacing arthroplasty.
All metal implants--and metal-on-metal bearings in particular--corrode and cause a release of metal ions. Because cobalt and chromium have been shown to be carcinogenic and mutagenic in human and animal models, systemic toxicity and cancer risk are considered to be possible disadvantages of the metal-on-metal articulation. This study was designed to investigate the serum concentration profiles of chromium, cobalt and molybdenum after implantation of a Birmingham hip resurfacing arthroplasty (BHR) and a cementless total hip replacement with a 28-mm Metasul articulation (MTHR), over the first 2 years after implantation. ⋯ During the first 2 years after surgery, the Birmingham hip resurfacing arthroplasty leads to a significantly greater increase in serum chromium and cobalt levels than the 28-mm metal-on-metal MTHR. Observation of patients over a longer period will be necessary in order to evaluate any chronic adverse effects to the system due to elevated chromium and cobalt serum concentrations.
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Comparative Study
No difference in tibial lengthening index by use of Taylor spatial frame or Ilizarov external fixator.
Different methods and devices are used to perform lengthening and deformity reconstruction in the tibia. Recently, the Taylor spatial frame (TSF) has been introduced as a computer-assisted and versatile external ring fixator. Lengthening index (LI) and complications are important result parameters, and the aim of this study was to review our first 20 tibial segments operated with the TSF and to compare the results with our experience of using the traditional Ilizarov external fixator (IEF). ⋯ We found no difference between the TSF and IEF frames regarding LI and complication rate. However, rotational, translational, and residual deformity correction is easier to perform with the TSF.