Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 2000
Case ReportsRecurrent intrapelvic cyst complicating metal-on-metal cemented total hip arthroplasty.
Spontaneous intrapelvic masses causing vascular compression raise the suspicion of a neoplasm or infection. We present a patient who developed a recurrent intrapelvic cyst 14 years after a McKee-Farrar total hip arthroplasty which presented as acute onset of lower limb swelling, threatening the vascularity of the limb. ⋯ The most probable cause of the recurrence was the cement and metal wear debris. Such cysts have been described in the literature, but to the best of our knowledge, this is the only report that describes it complicating a metal-on-metal prosthesis.
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Arch Orthop Trauma Surg · Jan 2000
Anterior reconstructive spinal surgery with Zielke instrumentation for metastatic malignancies of the spine.
From March 1984 to April 1996, 60 consecutive patients with spinal metastasis underwent palliative surgery by anterior corpectomy and Zielke instrumentation. Their ages ranged from 21 to 76 years (mean 54 years). Thirty-two patients had metastasis to the thoracic spine, 20 to the lumbar spine, and 8 had both thoracic and lumbar metastases. ⋯ Forty of 52 patients with severe pain obtained significant symptomatic relief for 3 months or more, and 33 of the 46 paralyzed patients gained neural improvement. Sphincter dysfunction became better in 10 patients, and none became worse. We conclude that anterior corpectomy to decompress neural encroachment with instrumental reconstruction to stabilize the collapsed spine is a good adjunctive treatment in these highly selected patients.
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Arch Orthop Trauma Surg · Jan 2000
The initial fixation of the press-fit acetabular shell--clinical observation and experimental study.
The initial solid fixation of an uncemented acetabular component affects the amount of bone ingrowth. We had several problems with broken screws in cases of acetabular revision. ⋯ Our thirty cases undergoing 2 mm under-reaming show good initial stability. The aim of our biomechanical study was to assess the most suitable degree of under-reaming of the bony acetabulum for the implantation of an uncemented hemispherical porous coated component.
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We measured radiographically the interspinous distance in 50 normal children and in 50 children with congenital dislocation of the hip. The value increased proportionally with age in normal children, but not in those with congenital dislocation of the hip. Our results indicate that a bony parameter, rather than the age of the child, is suitable for the indication of lower age limit for Salter's innominate osteotomy.
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Documentation is key to quality assurance (QA): Data must be complete, plausible, and comparable, and then analyzed to implement corrective measures. Important factors are: qualification of care-providing staff, equipment and implants available (structural quality), effective scheduling of operations and therapy management (process quality), and patient status monitoring (outcome quality). ⋯ An evaluation profile with the key quality indicators and a QA guideline is presented. A survey conducted in Germany, Austria, and Switzerland revealed: (1) up to 12-month waiting period for surgery in 6%, (2) only 40% written instructions, (3) data mostly written by hand, (4) differences in surgery planning and use of prosthesis passport, (6) inconsistent data analysis, (7) corrective measures rarely implemented.