Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 1992
Bad results after anterior advancement of the tibial tubercle for patello-femoral pain syndrome.
Seventy-one patients with patello-femoral pain syndrome were re-examined an average of 10 (range 8-12) years after anterior advancement of the tibial tuberosity. The clinical results were excellent in 8 (11%), good in 20 (28%), fair in 16 (23%), and poor in 27 (38%). ⋯ The results were worse in patients with Outerbridge grade III-IV cartilage damage. Since the clinical results deteriorated with time, this surgical procedure should no longer be used to treat patients with patello-femoral pain syndrome.
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Thirty-one surgically treated cases of synovial sarcoma were reviewed. The mean age of the patients at primary surgery was 37 years (range 10-78 years). Twenty-nine of the tumors were of the biphasic type and two were monophasic. ⋯ The 5-year survival rate in this study was 55% and the 6-year survival rate 50%; after 6 years there were no recurrences. The primary treatment should follow the same guidelines that are currently given for other soft-tissue sarcomas: wide and radical excisional margins should be aimed at. Excisional treatment even of repeated pulmonary recurrences may be rewarding.
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In this study the function of the knee measured at a medium-follow-up of 5-6 years was correlated with influencing factors concerning the implant of total condylar knee prosthesis in 90 patients. The only variable affecting postoperative extension was the preoperative range of extension whereas postoperative flexion was influenced by the preoperative flexion, valgus deviation of the preoperative AP tibial-femoral angle, position of the patella, and thickness of the resection of the distal femur cut.
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Arch Orthop Trauma Surg · Jan 1992
A simpler surgical technique to treat aseptic nonunion-associated femoral length discrepancy.
In a prospective study from December 1986 to August 1989, 17 consecutive patients with femoral shortening due to aseptic nonunion of femoral shaft fractures were treated with limitedly open Gross-Kempf locking nailing with a lengthening procedure. Patients were followed up for at least 1 year (average 25 months). There was a 88.2% union rate with an average union period of 5.2 months. ⋯ Complications (11.8%) were 5.9% implant failure and 5.9% nonunion which were not difficult to manage. No neurovascular complications were noted. We conclude that for 5 cm shortening or less in femoral aseptic nonunion, this treatment constitutes the simplest technique and can achieve a very satisfactory result.
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Arch Orthop Trauma Surg · Jan 1992
Inflammatory reactions in primary osteoarthritis of the hip and total hip prosthesis loosening.
In 14 patients [9 with loosened total hip arthroplasty (THA), 5 with primary osteoarthritis], the inflammatory cell infiltrate was characterized in cryostat tissue sections using antibodies against subsets of macrophages and lymphocytes. In all patients the abundance of a mature type macrophage (25F9+) was observed, whereas 27E10+ macrophages, characteristic of acute inflammatory reactions, were not seen in primary osteoarthritis but were found in 4 out of 9 patients with THA loosening. The RM3/1 + macrophage phenotype was seen in some of both sets of patients (osteoarthritis 4/5; THA loosening 4/9). ⋯ The data reveal remarkable differences between the two groups of patients. While the inflammatory infiltrate in patients with osteoarthritis lacks the characteristics of acute inflammation, in patients THA loosening the inflammatory process seems to be determined by periods of acute reactions. The occasional presence particularly of T-helper cells suggests that the inflammatory process is less T-cell but rather macrophage-driven.