Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Apr 2008
Comparative StudyComparison of periprosthetic bone remodelling after implantation of anatomic and straight stem prostheses in total hip arthroplasty.
Total hip arthroplasty changes bone loading conditions in the proximal femur and induces adaptive remodelling of the periprosthetic bone. These remodelling processes depend on many implant-specific qualities, e.g. material and elasticity of the stem. The objective of this study was to investigate the effect of the stem design on periprosthetic bone remodelling after insertion of an anatomic stem with proximal fixation and the direct comparison to a straight stem prosthesis. ⋯ After implanting a CTX-S prosthesis, as opposed to PPF prostheses, a different pattern of periprosthetic bone remodelling with a slighter hypertrophy of the distal periprosthetic parts was observed. This implies that the extensive proximal, more physiological bone loading of the anatomic stem as well as the removal of less bone while implanting the stem reduces the negative effects of unphysiological strain distribution and stress shielding. The BMD loss in the medial proximal neck cannot be avoided with this stem design either. The lack of significant BMD changes in the second post-operative year suggests that a stabilisation of bone remodelling processes occurs.
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Arch Orthop Trauma Surg · Apr 2008
Comparative StudyComparison of the short-term functional results after surface replacement and total shoulder arthroplasty for osteoarthritis of the shoulder: a matched-pair analysis.
The purpose of this clinical study with a matched-pair design was to compare the functional short-term results obtained in patients with primary osteoarthritis of the shoulder treated with cementless surface replacement of the humeral head (CUP) with those obtained after total shoulder replacement (TSR). ⋯ At short-term follow-up, surface replacement as a technically less demanding technique provided only slightly inferior results to TSR. We therefore believe that CUP arthroplasty is a therapeutic option and can be recommended in patients with primary osteoarthritis when limited to strictly defined indications.
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Arch Orthop Trauma Surg · Mar 2008
Case ReportsBilateral non-traumatic acetabular and femoral neck fractures due to pregnancy-associated osteoporosis.
Pregnancy-associated osteoporosis is a rare disorder and its pathophysiology remains unknown. We report a case of pregnancy-associated osteoporosis in a 27-year-old primiparous patient who revealed bilateral hip pain during early postnatal period. The plain radiographs and computerized tomography showed bilateral femoral neck and acetabular fractures. ⋯ The case was treated successfully by bilateral cementless total hip arthroplasty. Bone mineral density increased after 2 years of treatment with calcium-vitamin D, calcitriol and alendronate. Diagnosis of pregnancy-associated osteoporosis should be suspected when hip pain occurs during pregnancy or in the post-partum period as it can lead to acetabular and femoral neck fractures.
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Arch Orthop Trauma Surg · Mar 2008
A new tourniquet system that determines pressures in synchrony with systolic blood pressure.
This study reports the results of the clinical use of a new tourniquet system for surgery of the lower extremity that can determine tourniquet pressure in synchrony with systolic blood pressure. ⋯ The conventional tourniquet pressure in the lower extremity is 300 or 350 mmHg, whereas this synchronized system required less pressure, making it a safe, useful device for controlling a bloodless surgical field in lower extremity surgery.
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Arch Orthop Trauma Surg · Mar 2008
Case ReportsExtreme complications of Fixion nail in treatment of long bone fractures.
The authors present their experience related to extreme complications in treatment of diaphyseal fractures of the long bones with application of the Fixion expansion intramedullary nail in a total of 48 surgeries. We have encountered six (12.5%) extreme complications in the management of fractures of 3 humeral, 2 tibial, and 1 femoral bones during its application procedure and postoperative follow-up. Of six cases, two with humeral and tibial fractures developed nonunion and rotational instability because of failure of inflation of the Fixion nail. ⋯ Application may need special training. Since the Fixion has not got rotational stability and rigidity as conventional nailing systems, bending and breaking of the nail may occur during postoperative period in patients with over obesity and hyperactivity. In patients with osteogenesis imperfecta, it may not be the first choice as a nailing system.