Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 2000
Transtrochanteric rotational osteotomy for osteonecrosis of the femoral head with preoperative superselective angiography.
A prospective radiologic and scintigraphic study was made of 15 joints in 12 patients who underwent transtrochanteric rotational osteotomy of the femoral head after identifying by preoperative superselective angiography which arteries should be preserved during surgery. The preoperative superselective angiography revealed that the blood supply to the femoral head was provided by the medial femoral circumflex artery in 12 joints and a branch of the internal iliac artery in 3 joints. ⋯ At the follow-up examination made after at least 2 years, there were no cases of collapse of the new femoral head weight-bearing site, and also there were no cases with a large cold area in the femoral head on the scintigram obtained 2 months postoperatively. For this operative procedure, the nutrient arteries of the femoral head should be confirmed by preoperative superselective angiography, and it is essential that these arteries be preserved during surgery.
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Arch Orthop Trauma Surg · Jan 2000
Comparative StudyUltrasonically driven instruments in the transfemoral approach--an aid to preservation of bone stock and reduction of implant length.
The transfemoral approach to the femur with implantation of the Wagner SL stem provides a means of dealing with the difficult revision problems of extensive endosteolysis and with peri-prosthetic fractures. This surgical approach has been modified such that with the aid of an ultrasonically driven cement removal instrument (OSCAR) the length of the osteotomy is reduced, preserving bone stock, and it is possible to implant a shorter prosthesis in approximately 60% of cases.
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Arch Orthop Trauma Surg · Jan 2000
Case ReportsGiant cell tumor of rib--rare location on the anterior aspect.
Giant cell tumor rarely occurs in ribs, where it presents posteriorly. We present a report of a giant cell tumor of bone occurring anteriorly in the rib with a review of the literature.
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Arch Orthop Trauma Surg · Jan 2000
Loosening pattern in a cementless custom-made hip stem: X-ray analysis, finite-elements and photoelasticity measurements.
Thirty-three X-press cementless stems (Depuy) manufactured according to standardized X-rays were inserted from 1992 to 1994. The patients' mean age was 49 (range 15-79) years with a mean follow-up of 32 (+/-6) months. A characteristic radiographic pattern of aseptic loosening with erosion of the medial cortex by the tip of the stem occurred in 28 patients and a valgus shift of the implant in 14 cases. ⋯ The intertrochanteric fit and fill obviously resulted in an unfavorable distribution of contact areas, including peaks of high stress on the medial tip of the stem. These experimental findings are even evident for a postulated rotational stability. The clinical and radiographic results of the cementless X-press stems do not seem to support the fixation concept of intertrochanteric fit and fill of femoral components.
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Arch Orthop Trauma Surg · Jan 2000
Pathology of femoral head collapse following transtrochanteric rotational osteotomy for osteonecrosis.
We investigated the pathology of femoral head collapse following transtrochanteric anterior rotational osteotomy. Six femoral heads were obtained during total hip arthroplasty some 2-12 years after osteotomy. ⋯ In newly created subchondral areas at weight-bearing sites, trabecular thickness and the number of trabecular bones had decreased, with few osteoblasts, osteoclasts, and osteocytes being present, resulting in a coarse lamellar structure of the trabecular bone. These findings suggest that transposed areas in cases of failure consist mostly of low-turnover osteoporotic lesions which could cause collapse of the femoral head.