Zeitschrift für Orthopädie und Unfallchirurgie
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Comparative Study
[Is there a bone-preserving bone remodelling in short-stem prosthesis? DEXA analysis with the Nanos total hip arthroplasty].
It has been suggested that the use of a short-stem prosthesis could conserve proximal bone by proximal load transfer. Proximal stress shielding should be reduced, a phenomenon that has been associated with bone resorption around traditional stems. Bone remodelling of a metaphyseal fixed stem (Nanos, Smith & Nephew Int.) was analysed by the dual-energy x-ray absorptiometry. ⋯ The desired proximal load transfer of a short-stemmed implant in the metaphyseal region of the proximal femur could not be reached with this device. On the basis of the excellent clinical results of the patients operated with the Nanos short-stem prosthesis we conclude that the component induces bone ingrowth in the lateral/distal region of the proximal femur.
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With regard to total replacement of the hip, revision arthroplasty poses a challenge especially for younger patients. In spite of substantial improvements, new materials and operation techniques are still not able to prevent a shorter running life of prostheses in this group. The present work aims at evaluating clinical and radiological mid-term results of the femoral neck prosthesis CUT (ESKA Orthodynamics Lübeck) to answer the question of whether this implant is recommendable for younger patients. ⋯ This study demonstrates the CUT prosthesis as a bone-preserving prosthesis with good functional and radiological results and therefore as an alternative joint replacement in younger patients.
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In spite of the cumulating evidence for the prognostic relevance of illness perceptions regarding the course of disease and recovery of hip and knee joint patients, there are still no studies that examine the effects of these perceptions on postoperative functioning as assessed by clinical ratings. The aim of this inception cohort study was to describe the course of functioning following a hip or knee joint replacement over a period of one year and to analyse moderator-type effects of illness perceptions in order to develop strategies for preoperative counselling and postoperative rehabilitation. ⋯ The results confirmed the prognostic relevance of illness perceptions for the functional outcome and indicate the importance of preoperative counselling and the potential benefit of patient-oriented education that is aimed at modifying illness perceptions.
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Comparative Study
[Medium-term results of anatomic straight-shaft IMAGE implantation in primary hip joint endoprosthetics--a prospective study].
The IMAGE prosthesis was developed with the objective of proximal load induction to avoid stress shielding and proximal bone resorption. In this study patients were followed clinically and radiologically with a special emphasis on osteointegration of the shaft in the proximal and distal regions. In addition, the reconstruction of the bony geometry of the proximal humerus was investigated. ⋯ Proximal stress transmission can be supported and the danger of stress shielding can be reduced by means of an appropriate design of a prosthetic stem. Distal corticoid hypertrophy was found in only 19% of the patients with the prosthesis model investigated as compared to 60% having prostheses with distal femoral anchoring. The medium-term clinical results are excellent, so that the shaft appears suitable for primary as well as secondary osteoarthritis of the hip joint.