Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 2000
Comparative StudyMortality after total knee arthroplasty in patients with osteoarthrosis and rheumatoid arthritis.
Total knee arthroplasty (TKA) is a widely used procedure in the treatment of severe destruction of the knee joint because of osteoarthrosis (OA) or rheumatoid arthritis (RA). The aim of this study was to explore whether there is an increased mortality in patients after TKA with the underlying diagnosis OA or RA compared with the general population. We studied a consecutive series of 422 primary TKAs with a hinged Blauth prosthesis in 330 patients (OA: 208 patients, 175 women, 33 men; RA: 122 patients, 109 women, 13 men) with a mean follow-up of 6 years (range 0-20 years). ⋯ SMRs of patients suffering from RA showed a clear shortening of the life span (women: 2.92, 95% CI 2.17-3.85; men: 3.09, 95% CI 1.0-7.19). In spite of the risk of intra- and perioperative complications and further operative procedures necessary because of late complications, the implantation of a knee prosthesis per se does not necessarily significantly reduce the life expectancy in patients with OA. Patients with RA who require the implantation of a total knee prosthesis obviously represent a high-risk group with a high mortality rate.
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Arch Orthop Trauma Surg · Jan 2000
Comparative StudyCemented Lubinus and Furlog total hip endoprosthesis: a 12-year follow-up study of 175 hips comparing the cementing technique.
We analyzed 175 total hip replacements with cemented Lubinus and Furlong arthroplasties in 164 patients with a median age of 65 (32-80) years and followed them for 12 years to evaluate and compare the efficacy of total hip prosthesis designs. Survival analysis was combined with an analysis of radiological findings and a study of functional outcome of the patients. The 12-year survival of Furlong arthroplasty in patients of 60 years of age and older was O.85 (95% CI 1.00-0.52). ⋯ We conclude that cemented arthroplasty affords a notable alternative with satisfactory long-term survival and function. The better survival of cemented cup than the stem may be utilized as a basis for "reverse" hybrid arthroplasty. Adequate long-term follow-up of all arthroplasties as a quality maintenance and to prevent difficult revisions is a major challenge.
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We report a case of a nerve sheath ganglion of the ulnar nerve at the canal of Guyon. This case involved a ganglion which was confined to the epineurium of the ulnar nerve. and it was completely excised without any damage to the nerve fiber. A nerve-sheath ganglion is rare, but it should be considered in the differential diagnosis of any tumor which is causing neural disturbance.
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Arch Orthop Trauma Surg · Jan 2000
Case ReportsSolitary osseous hemangioma outside the spinal and craniofacial bones.
Bone hemangioma is mainly seen in the skull and spine, and rarely occurs in other bones. We report herein four cases of osseous hemangioma arising in rare sites: In two cases, on a rib; a faintly painful mass in one case located on the scapula; and progressive pain in one case located on the ischium. The tumors presented clinically as incidental lesions on radiographs. ⋯ Markedly high signal intensity on T2-weighted magnetic resonance images was a characteristic finding. Open biopsy resulted in severe blood loss, but needle biopsy was performed safely under computed tomography guidance. It is important to note that bone hemangiomas may be misdiagnosed as malignant tumors.
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Arch Orthop Trauma Surg · Jan 2000
Comparative StudyFixation of proximal tibia fractures by a retrograde nail: a biomechanical investigation.
Surgical treatment of proximal tibial fractures requires open reduction and internal fixation. The operative exposure causes additional soft-tissue injury and reduces the blood supply to the bone. A cephalograde tibial nail should offer comparable mechanical stability without these disadvantages. ⋯ While both implants exhibited comparable stiffness under sagittal loading, the plate had a higher rotational and varus stiffness. Despite this higher stiffness, rotational displacements at the fracture gap were nearly twice as large for this implant during loading. We conclude that the retrograde nail provides similar mechanical stability to plate fixation for proximal tibial fractures, while the closed reduction and soft-tissue preservation of this new technique are definite advantages.