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Biomedical subjects

D M Dall

Publications and source records attributed to D M Dall.

At least 19 recordsLinked to original sources
PubMed1996

Surgical management of intra- and postoperative fractures of the femur about the tip of the stem in total hip arthroplasty.

Six techniques for the surgical management of fractures of the femur about the tip of the stem of a total hip arthroplasty were evaluated. Seven embalmed human femurs were prepared to receive the correct-size femoral component of a total hip system. A transverse osteotomy was performed at the level of the tip of the stem. Stability and strength of each reconstruction were tested on each femur under semidynamic loading conditions. This study showed that cementless revision to a long-stem prosthesis does not provide adequate stability. The highest strength and stability were achieved by supplementing the long-stem conversion with allograft struts and cable cerclage. Good results were obtained by lateral compression plating with unicortical screws proximally. Failure was due to pull-out of the proximal screws.

Aged↗
PubMed1995

Loss of bone stock with cementless hip arthroplasty.

One hundred four porous-coated anatomic cementless hip arthroplasties followed from 2 to 6.5 years (mean, 50 months) were studied. Ninety-four percent had excellent clinical results. Thigh pain occurred in 23% of patients, but was severe in only two. "Cancelization" and rounding off of the calcar were noted in 83% of hips, whereas localized osteolysis occurred in 24 femurs and one acetabulum. Ten of these measured more than 10 mm, and all of those in the femur were located proximally. None of these patients were symptomatic and none have come to revision. Ultrahigh-molecular-weight polyethylene wear and plastic debris were implicated as the cause of osteolysis. Lytic lesions were seen only after 3 years and occurred only in patients with 32-mm femoral heads in whom the outer diameter of the acetabular component was 52 mm or less. Use of excessively thin ultrahigh-molecular-weight polyethylene in these patients may have predisposed them to accelerated wear. Section modulus mismatch resulting in stress protection is considered as an alternate mechanism of proximal bone resorption.

Adolescent↗
PubMed1993

Fracture and loosening of Charnley femoral stems. Comparison between first-generation and subsequent designs.

We report the results of a 4- to 17-year clinical and radiological follow-up of 264 Charnley first-generation stems in comparison with those of 402 second- and subsequent-generation stems. The incidence of fracture was 4.1% in first-generation stems and 0.5% in second- and subsequent-generation stems. The incidence of stem loosening requiring or likely to require revision was 3.1% in first-generation and 11.4% in second-generation stems. We believe that the increased loosening rate in second- and subsequent-generation stems is due to their larger cross-sectional area, which produces an increase in flexural stiffness.

Adolescent↗
PubMed1993

811 Charnley hips followed for 3-17 years.

10-12 year survivorship analysis of 811 primary or conversion Charnley arthroplasties showed 89 percent probability of mechanical survival (revision excluding sepsis). The mechanical failure rate was 7 percent, and more stems required revision than sockets. The anterio-posterior radiographs of 630 unrevised hips, with a minimum 3-year follow-up, were evaluated using the CART system of terminology. Cement-bone radiolucency was present in 50 percent of sockets and 18 percent of stems. Substantial loosening was present in 6 percent with 94 percent probability of survival at 10-12 years.

Adolescent↗
PubMed1992

A scoring system to determine radiological loosening in cemented total hip arthroplasty.

A radiological scoring system was developed to identify grades of loosening of the components of a cemented hip replacement. In grade 1, there are mild changes, usually of minor significance; in grade 2 moderate changes which need regular observation, and in grade 3 severe changes which indicate impending failure. Three parameters are used for the socket, giving a score of 10 points, and 5 for the stem, with a score of 15 points. This method can be used to provide a comparison between different series with a long-term follow up.

Evaluation Studies as Topic↗
PubMed1992

Survivorship of cemented total hip arthroplasty in patients 50 years of age or younger.

One hundred fifty-six Charnley low-friction arthroplasties performed in patients 50 years of age or younger are reviewed. Excluding sepsis, survivorship analysis showed a 12% probability of mechanical failure at 10 years. The detailed clinical and radiological results of 130 hips with a 3-16-year follow-up period are presented. Revision surgery was required in 14 hips (10.8%), for the following reasons: sepsis (2.3%), loose sockets (2.3%), loose stems (5.4%), and stem fracture (0.8%). Evidence of radiological loosening indicative of pending failure was present in 14 hips (12.0%). At 10 years the predicted failure rate of the surviving hips was 12%.

Adolescent↗
PubMed1992

Long-term results of Charnley low-friction arthroplasty of the hip.

The long-term results of 488 Charnley low-friction arthroplasties, performed by one surgeon, were analysed. Radiological changes were assessed using the CART nomenclature. If sepsis (1.4%) is excluded, the mechanical failure rate of one or both components requiring revision surgery was 6.5%. The incidence of radiological loosening of components was 4.7%. Kaplan-Meier survival analysis predicts an 88% mechanical survival of components at 10-12 years.

Adult↗
PubMed1988

Long-term results of Charnley low-friction arthroplasty of the hip.

The long-term results of 73 Charnley low-friction arthroplasties with follow-up of 10-14 years are presented. Eight hips required revision for socket migration resulting from excessive medialisation of the cup (2, 2.7%); breakage of the femoral stem (5, 6.8%); and loosening (1). A further 5 hips had radiological changes suggesting that they would require revision in the foreseeable future. Sixty hips (82.2%) remained clinically excellent with minimal radiological changes.

Adult↗
PubMed1986

Accelerated polymerization of acrylic bone cement using preheated implants.

This article is an account of a procedure to accelerate polymerization of polymethylmethacrylate during total hip arthroplasty by preheating the stem of the femoral prosthesis. The increased temperature is shown to have a definite beneficial effect with regard to accelerated polymerization. Experimental investigations are presented to verify this supposition.

Bone Cements↗
PubMed1986

Charnley low-friction arthroplasty of the hip. Long-term results in South Africa.

Long-term results of 98 Charnley low-friction arthroplasties were followed for a period of a mean of 12 years; 98 of 470 operations qualified for this strict long-term study, 78 (79.6%) with excellent results. If excessive medialization of the cup is avoided, socket complications appear to be minimal (4%). The majority of femoral component failures resulted from femoral stem breakage. Only four hips (4.08%) developed loosening of the femoral stem.

Adult↗
PubMed1983

Re-attachment of the greater trochanter. The use of the trochanter cable-grip system.

In comparison with monofilament wire, multifilament cable was found to be a more suitable material for fixation of the greater trochanter. It is versatile, easy to work with and has superior mechanical properties. The "trochanter cable-grip system" was developed to exploit the use of multifilament cable as a means of reattaching the greater trochanter and experimental studies have yielded excellent results. This system was subjected to clinical trials for over four years in 321 hips and, at its present state of development, the incidence of detachment has been reduced to 1.5 per cent and that of cable breakage to 3.1 per cent.

Biomechanical Phenomena↗