Operative Orthopädie und Traumatologie
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Oper Orthop Traumatol · Mar 2007
Clinical TrialStabilization of the posterior pelvic ring with a slide-insertion plate.
Minimally invasive stabilization of the posterior pelvic ring in type C injuries. ⋯ 34 patients with an average age of 42.6 years were treated according to the described method from 1998 to 2005; 18 were polytraumatized. The anterior pelvic ring was also stabilized by surgery in 28 patients for eleven of whom it was the first intervention in a two-stage procedure. 25 patients were available for clinical and radiologic follow-up at 17 months, on average. The plain radiographs after 1 year showed a very good outcome in 16 patients (maximal displacement of the posterior pelvic ring < 5 mm) and a good outcome in eight patients (displacement of 5-10 mm). In two patients there was loss of reduction in the 1st postoperative year despite a very good reduction result immediately postoperatively (dislocation < 5 mm), whereby the dislocation for one patient was < 10 mm on the final radiograph and 19 mm for the other. One patient presented with a late infection 11 weeks postoperatively that healed after implant removal and wound debridement. In two other patients, prominent screw heads, which were used for refixation of the osteotomized posterior superior iliac spine, had to be removed under local anesthesia in the 10th postoperative week. The further course for these two patients was uneventful. In one patient the implants were retrieved in the 5th postoperative month because the patient complained of internal hot and cold sensations although the soft tissue was not irritated. The plates were removed in six other cases after the fracture/instability had healed, i. e., after 9-12 months, on average; in all other cases the implants were left in situ.
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Oper Orthop Traumatol · Mar 2007
Clinical TrialUncemented femoral revision arthroplasty using the modular revision prosthesis MRP-TITAN revision stem.
Restoration of a painless hip joint capable of bearing weight by uncemented implantation of a rotationally stable, modular revision stem anchored in the diaphysis. ⋯ 45 patients (n = 48 prostheses) with an average age of 67.2 years (min.-max. 42.4-87.4 years) were investigated. The average implantation time of the Modular Revision Prosthesis MRP-TITAN revision stem was 4.7 years (min.-max. 1.0-9.0 years). The Harris Hip Score for Paprosky bone defect types I-III had increased from 25.6 preoperatively to 71.4 postoperatively at the time of the final follow-up (< or = 0.05). Extensively defective bone was diagnosed preoperatively in 32 patients (> or = Paprosky IIB). Plain radiographs showed stable anchorage without migration in 44 patients. In one case, the stem (implantation time 2.36 years) was replaced due to increasing axial subsidence (> or = 5 mm). Good integration of bone graft with subsequent defect regeneration was seen in all patients with bone transplant (n = 30). Postoperative dislocation occurred in six patients and required closed reduction in four cases. Open reduction was performed in two patients, whereby the external rotation angle of the prosthetic neck was corrected without dismantling the distally anchored prosthetic stem components. The mechanical failure rate over the follow-up period of 9 years was one out of the 48 prospectively investigated prostheses. Rate of survival according to Kaplan-Meier was 97%.