Biomedical subjects

C T Trepte

Publications and source records attributed to C T Trepte.

14 recordsLinked to original sources

PubMed2003

[Soft tissue balancing in total condylar knee arthroplasty].

Soft tissue balancing and correct bone cuts are an entity in correcting malalignment in total knee arthroplasty, and cannot be considered isolated. Distinct bony deformations/deviations need enlarged soft tissue management. The extent of resection of the bone stock has to be planned exactly before the operation. Exact soft tissue balancing is necessary to stabilize the corrected knee. Soft tissue balancing has to be done primarily on the side of the contracture by lengthening of the shortened and contracted structures. After balancing the ligaments should have the same tension in extension and flexion together with the same height of the extension and flexion gap. Because of the classic resection of the tibial head, the femoral resection must follow the Insall-Line, that means 3 degrees to 5 degrees outer rotation in relation to the condyles. Only in this way a symmetric flexion gap can be achieved in combination with ligamentous stability in extension and flexion.

Arthroplasty, Replacement, Knee↗

PubMed1988

[Epiphysiolysis of the proximal tibia--an atypical sports injury?].

Epiphyseolysis of the proximal tibia is a most unusual injury. The case reports show that there was no adequate trauma leading to this damage. One has to argue, that disposition could be a predisposing factor. Therapy and prognosis of this injury are presented.

Adolescent↗

PubMed1987

[Animal experiment studies of the resistance to wear of a teflon ligament prosthesis].

In a randomised study the anterior cruciate ligament (ACL) was resected in 16 sheep and replaced by a PTFE-Ligament prosthesis. The device was examined 1/2 year and 1 year after implantation. 1 year after implantation the signs of wear were considerably greater than 1/2 year after implantation and the tensile strength was significantly decreased. As a result of the implantation technique and by the large volume, the device underwent an unphysiologically high mechanical stress, leading to early breakage. The improved implantation technique should result in lower mechanical stress in the larger human knee joint and a longer lifetime should be expected.

Animals↗

PubMedDate not supplied

[Incidence of joint-specific risk factors in patients with advanced cox- and gonarthroses in the Ulm Osteoarthrosis Study].

AIM OF STUDY: To determine the prevalence of joint specific risk factors in patients with different patterns of advanced hip and knee osteoarthritis (OA). METHODS: We performed a cross-sectional multicenter study in four orthopaedic hospitals in the southwest of Germany. A detailed medical history (date and nature of trauma, conservative and surgical treatment of congenital or acquired joint disorders known as secondary causes of OA) and radiographic evaluation (sequelae of hip dysplasia, slipped capital femoral epiphysis or other malformations) was obtained in 809 patients with advanced hip (n = 420) or knee (n = 389) osteoarthritis, which required unilateral total joint replacement. According to the presence or absence of joint specific risk factors, patients were classified as having secondary or primary (idiopathic) OA. RESULTS: In 41.7% (25.5%) of patients with hip OA and 33.4% (11.1%) of patients with knee OA some predisposing abnormality of the operated (or contralateral) joint could be observed. In hip OA the underlying pathological conditions were mainly hip dysplasia (25.0% in the operated joint and 14.8% in the non-operated joint) and slipped capital femoral epiphysis (7.1% and 14.8%), while knee OA was most often associated with a history of severe trauma (28.6% and 8.3%) CONCLUSION: While there is a lack of comparable investigations in patients with advanced knee OA, the presented data is somewhat contradictory to earlier reports of the prevalence of identified underlying risk factors in patients with hip OA. The reported differences, however, might be attributed to different methodological approaches and could also resemble recent changes in the multifactorial ethiopathologic concept of OA.

Aged↗

PubMedDate not supplied

[Medium-term results following implantation of cemented Weller type endoprostheses].

102 cement-fixed endoprothesis of Type Weller I, which were followed up for six years on average, showed good results. We saw three aseptic loosenings and one septic loosening (1.5 years after implantation). Circumscribed progressive resorption of the cortical layer is a typical radiological sign of loosening of an endoprothesis. However, radiolucent lines do not prove aseptic loosening. Even stems with a collar may sinter without loosening. No correlation was found between the type of the hip affection (osteoarthritis, aseptic necrosis of the hip, rheumatoid arthritis etc.) and the result of the operation. Regarding our results we consider cement-fixation in total hip replacement as a good procedure in elder patients.

Aged↗

PubMedDate not supplied

[Indications and results of knee endoprostheses without an axis].

An analysis of 93 unconstrained totalcondylar knee prostheses showed good to excellent results. There was no significant difference between cemented and uncemented knee replacement. The advantages of unlinked totalcondylar knees are: --the minor bone resection, which enables a sure fixation of a new prosthesis or an arthrodesis in case of loosening, --the stabilisation by the natural ligaments leading to a reduced force transmission in comparison to linked prostheses. If knee replacement is necessary the total condylar surface replacement should be the knee endoprosthesis of first choice.

Adult↗

PubMedDate not supplied

[Spontaneous ruptures of the extensor system of the knee following joint replacement in patients with rheumatoid arthritis].

Spontaneous ruptures of the quadriceps tendon and the patellar ligament following total knee arthroplasty in two patients with rheumatoid arthritis are reported. Degenerative and steroid-induced changes of tendinous tissue, circulation problems as well as mechanical changes to the patellofemoral joint by resurfacing the patella are discussed being possible causes of these complications of the extensor mechanism of the knee.

Aged↗

PubMedDate not supplied

[Revision interventions in aseptic and infected loose knee endoprostheses].

From 1984 to 1988 20 revisions for aseptic or septic loosening of knee prosthesis were performed. In 12 case there was an aseptic- and in 8 cases a septic loosening of the prosthesis. Most revision surgery for loosening of knee replacement needs reconstruction of bone stock. In loosening of unconstrained knee prostheses (uni-, totalcondylar knees) it was possible to insert a total condylar knee for revision surgery. Partially gross deviations had to be corrected, but in all cases a good alignment and ligamentous stability were effected. In septic loosening we had good experience with the two stage procedure. We temporarily implanted a gentamycine-PMMA-Spacer to avoid soft tissue contracture and to inhibit fusion of the cancellous bone. Arthodesis after knee replacement is difficult to manage, because the sclerotic bone of the site the prosthesis doesn't easily fuse.

Anti-Bacterial Agents↗

PubMedDate not supplied

[Indications and results of the surgical treatment of distal intra-articular humeral fractures in the elderly].

In this paper we review 16 patients with closed intercondylar fractures of the distal end of the humerus that had open reduction and internal fixation. All patients were older than 60 years of age. Using the classification system of Müller et al. 6 fractures were classified as type C2 and 10 fractures as type C3. The surgical procedures and the types of internal fixation of the fractures allowed early postoperative mobilisation (3rd postoperative day). A rating scale modified according to Cassebaum was used for the results. At a mean follow-up of 4.2 years 3 patients were rated as excellent 9 as good and 2 as fair. No severe complications were registered.

Aged↗

PubMedDate not supplied

[Ender nailing of per and subtrochanteric fractures. Results and complications].

An evaluation of 84 trochanteric and subtrochanteric fractures, treated with Ender pins in the Department of Orthopaedic Surgery (University of Heidelberg) proved to be of instant success in 66 (78%) cases. A reoperation had to be performed in 10 (12%) cases, in 3 of these reoperation the pins had to be redriven. The use of Ender pins failed in 7 patients, a total hip arhtroplasty became necessary. The mortality was 14%. A third of the cases showed an external malrotation which, however, is of no relevance in older people. The intermedullary fixation with Ender pins is a useful operative procedure. Stable internal fixation can be achieved even in sever trochanteric ans subtrochanteric fractures. In case the form of the fracture, the age and the general condition of the patient are satisfactory, a total hip arthroplasty should be considered.

Adult↗

PubMedDate not supplied

[Initial experiences with the cementless PM endoprosthesis].

A follow up of 40 cementless fixed endoprostheses type PM showed good results, similar to cement fixed prostheses. In cementless fixation seem to be more early complications and less late complications, so these results are encouraging what concerns cementless fixation.

Adult↗

PubMedDate not supplied

[Experiences with Wagner's cup prosthesis].

Surface replacement is an alternative procedure especially in younger patients who absolutely need hip replacement. Accurate diagnosis is imperative and the range of indications is naturally small. A follow up study of 44 patients (range, 10 months to 4 years) showed 2 loosenings (5%); other severe complications were not seen. In 39 (89%) hips was no more pain after operation and there was a distinct improvement of motility in 39 (89%) cases. Avascular necrosis should not be treated by surface replacement. Primary inflammatory diseases (rheumatoid arthritis) seem to have a higher incidence of complications, especially when long time treated with large doses of steroids. Cortisone medication promotes avascular necrosis of the hip and lytic enzymes coming from the pannus might be another reason for loosening. According to our experience the position of the cup according to varus or valgus has no influence on the result of the operation. The Watson-Jones approach seems to be better than the approach recommended by Wagner, because paraarticular calcifications are seldom seen.

Adult↗

PubMedDate not supplied

[Results with ceramic-on-ceramic sliding endoprosthesis completely or partially fixed without cement].

41 patients with ceramic total hip arthroplasty were followed up (on an average 2.8 years p. op., mean age 49.7 years). 9 prostheses were of type Lindenhof, 32 were of type Mittelmeier. In 27 cases cementless implantation was performed, 7 cases were reimplants. Hip scores according to Merle d'Aubigne reached 41 to 18 in 11 cases, 12 to 14 in 12 cases, and less than 12 in 17 cases. In cementless total hip arthroplasty a major problem appears to be associated with the anchorage of the femoral stem. Using a screw type fixation of the acetabular component seems to guarantee good anchorage, this was found also for reimplants. Doubts are raised about the use of ceramic on ceramic combination in arthroplasty.

Adult↗

PubMedDate not supplied

[Axisless knee endoprosthesis in patients with chronic polyarthritis].

Axial-free knee prostheses have proved their worth in the treatment of arthritic knees. Normal axial alignment and physiological ligamentous guidance can be accomplished by this type of prosthesis, even in cases of severe deformity and instability. In addition, unconstrained prostheses show some important advantages in comparison to constrained prostheses.

Adult↗