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Biomedical subjects

F Kerschbaumer

Publications and source records attributed to F Kerschbaumer.

At least 37 records · Page 2Linked to original sources
PubMed2000

[Thoughts on the use of mechatronic implantation aids in minimal approaches in hip prostheses].

A new concept of THR surgery is presented: A combination of limited surgical approach, intraoperative digitizing, and use of a semi-active robot shows the important advantage of easy registration, reproducible positioning of surgical instruments, and less invasive surgery. Using this system originally designed for accurate socket implantation, it will be possible to perform total THR in the future. For preoperative planning, we are currently investigating the use of biplanar digital radiographics with transformation into a 3D-model in order to avoid CT scans in the pelvic area.

Arthroplasty, Replacement, Hip↗
PubMed1999

[Arthrodesis of the talocalcaneal joint in adults. Indications, procedure, outcome].

Affections of the rear-foot-complex may occur because of various etiologies and show differing pathogenetic patterns. Besides posttraumatic changes, the rheumatoid arthritis, primary disorders and neurologic complications are registered. Biomechanically the hindfoot-complex is characterised by the joint play of ligamentous, bony and tendineal structures. Referring to diagnostics the clinical and radiologic examination are predominant. In the literature there is no uniform opinion concerning the therapeutic algorithm. The arthrodesis as a surgical procedure is commonly used, nevertheless important differences may be stated with regard to the choice of the osteosynthesis or the number of the joints to be fused. We present biomechanical models, diagnostic examinations and operative procedures in this context. Our own results of patients who underwent surgical interventions involving joints of the lower rear-foot using the Kitaoka hindfoot-score are demonstrated.

Adult↗
PubMed1999

[Treatment of the ankle joint in rheumatoid arthritis with surgical and radiation synovectomy].

Results of surgical synovectomy and radiation synovectomy (radiosynoviorthesis) of the tibiotalar joint in rheumatoid patients are reported. The staged concept for management of the rheumatoid ankle joint is presented which is based on the radiographic appearance of disease progression. Results of 16 rheumatoid patients with disease to the ankle joint suggest that pain and walking capability is positively influenced by synovectomy and radiosynoviorthesis. Follow-up of 30 months revealed no deterioration of postoperative clinical improvement. In the absence of contraindications to radiosynoviorthesis it is suggested to combine arthroscopic synovectomy with radiosynoviorthesis for the treatment of early stages of rheumatoid disease of the ankle joint. Open synovectomy is preferred to arthroscopic synovectomy, if tenosynovectomy is simultaneously required.

Ankle Joint↗
PubMed1999

Metacarpophalangeal joint arthroplasty in rheumatoid arthritis: results of Swanson implants and digital joint operative arthroplasty.

We discuss 69 metacarpophalangeal (MP) implant arthroplasties performed in 30 patients with rheumatoid arthritis. The follow-up averaged 5 years. We studied 19 finger joint prostheses by Condamine, digital joint operative arthroplasty (stabilized version; DJOA) and 50 flexible silicone Swanson implants. We used a new comprehensive scoring system to evaluate the MP alloarthroplasties. Such a scoring system incorporates clinical and radiological data. The outcome following MP joint replacement with DJOA was never evaluated as 'good'; in 11 joints the result was 'fair', and in 8 joints, 'poor'. As regards MP arthroplasty with Swanson implants, the results were evaluated as 'good' in 40 joints, as 'fair' in 10 joints, and in none as 'poor'. In our series, DJOA did not provide stability in arthritic MP joints. In all joints replaced with DJOA, dislocation of the articulating surfaces and signs of loosening were present. We regard three factors as being the main causes contributing to the poor outcome of DJOA when used as MP replacements. Firstly, the proximal prosthetic component is poorly matched to the anatomical shape of the metacarpal bone (conisation of the bone). Secondly, adequate coaptation cannot be achieved with this prosthetic design, even in the presence of extensive soft-tissue reconstruction. Thirdly, the use of polyethylene in MP joint replacements is questionable. In contrast, the silicone Swanson implants in our series provided superior results when used as MP implants in the rheumatoid hand.

Adult↗
PubMed1999

Stage-related surgery for cervical spine instability in rheumatoid arthritis.

Thirty-six consecutive patients with cervical spine instability due to rheumatoid arthritis (RA) were treated surgically according to a stage-related therapeutic concept. The aim of this study was to investigate the clinical results of these procedures. The initial change in RA of the cervical spine is atlanto-axial instability (AAI) due to incompetence of the cranio-cervical junction ligaments, followed by development of a peridontoid mass of granulation tissue. This results in inflammatory involvement of, and excessive dynamic forces on, the lateral masses of C1 and C2, leading to irreducible atlanto-axial kyphosis (AAK). Finally, cranial settling (CS) accompanied by subaxial subluxation (SAS) occurs. According to these three separate pathological and radiological lesions, the patients were divided into three therapeutic groups. Group I comprised 14 patients with isolated anterior AAI, who were treated by posterior wire fusion. Group II comprised 15 patients with irreducible AAK, who were treated by transoral odontoid resection. The fixation was done using anterior plating according to Harms in combination with posterior wire fusion according to Brooks. Group III comprised seven patients with CS and additional SAS, who were treated with occipito-cervical fusion. Pre- and postoperatively, evaluation was performed using the parameters pain (visual analog scale), range of motion (ROM), subjective improvement and Health Assessment Questionnaire (HAQ). The neurologic deficit was defined according to the classification proposed by Ranawat. Radiographs including lateral flexion and extension views, and MRI scans were obtained. The average clinical and radiographic follow-up of all patients was 50.7 +/- 19.3 months (range 21-96 months). No perioperative fatality occurred. Postoperative pain was significantly relieved in all groups (P < 0.001). In group II a slight improvement in the HAQ was obtained. In groups I and II the ROM of all patients increased significantly (average gain of motion in group I: 11.3 degrees +/- 7. 8 degrees for rotation; 7.8 degrees +/- 5.6 degrees for bending; average gain of motion in group II: 21.5 degrees +/- 14.0 degrees for rotation; 17.2 degrees +/- 5.5 degrees for bending), while it decreased significantly in group III (10.7 degrees +/- 18.1 degrees for rotation; 6.7 degrees +/- 18.5 degrees for bending). Preoperatively 27 patients had a manifest neurologic deficit. At follow-up four patients remained unchanged, all others improved by at least one Ranawat class. All patients, except one, showed solid bony fusion. According to the significantly improved postoperative subjective self-assessment and the clinical and radiological parameters, transoral plate fixation combined with posterior wire fixation after transoral odontoid resection represents an effective reliable and safe procedure for the treatment of irreducible AAK in rheumatoid arthritis.

Aged↗
PubMed1999

[Radio-lunar Mannerfelt arthrodesis in rheumatoid arthritis].

PURPOSE: We present data of 27 radiolunate and 23 Mannerfelt arthrodeses in patients with rheumatoid arthritis. METHOD AND CLINICAL MATERIAL: Benefits of surgery, i.e. the reduction of pain, swelling, tenderness, and signs of instability as well as radiographic findings of carpal height, carpal collapse, progression of rheumatoid disease beyond the site of wrist fusion were assessed after a mean time of 44 months. RESULTS: Wrist pain and swelling were better managed by Mannerfelt than by radiolunate arthrodesis. Average grip strength of wrists with radiolunate fusion exceeded the strength developed in wrists with Mannerfelt-fusion. However, grip strength of wrists with Mannerfelt-fusion was greater than in the opposite unfused hand, while this was not found in wrists with radiolunate arthrodesis. Postoperative improvements in hand intensive activities were more frequent in the radiolunate fusion population. CONCLUSION: Advancement of carpal degeneration in radiolunate wrist fusions beyond the fusion site may indicate a rising number of symptomatic wrists with increase of follow-up time. Our results have led us to suggest radiolunate fusion for the non-dominant hand in patients with slow carpal progression of rheumatoid disease and especially if complete wrist fusion of the opposite--often dominant hand--has already been performed.

Adult↗
PubMed1998

[Combined arthroscopic and radiation synovectomy in rheumatoid arthritis].

In rheumatoid arthritis of the knee joint good results are obtained using arthroscopic synovectomy or radiation synovectomy. Aim of our study was to investigate, whether the combination of these two minimal invasive interventions achieves better results. First we performed arthroscopic synovectomy of the knee joint followed by radiation synovectomy with application of 111-222 MBq Yttrium-90 6 weeks later. In a prospective randomised clinical trial between 1987 and 1991 we performed radiation synovectomy on 22 knee joints and combined arthroscopic and radiation synovectomy on 26 knee joints. We explored the patients preoperatively, 6 weeks and 6 months postoperatively. In 1996 we evaluated 141 knee joints in a retrospective clinical trial. 90 Knee joints had been treated with the combined therapy, 39 only with radiation synovectomy and 12 only with arthroscopic synovectomy. Depending on the three different therapeutic interventions, the patients were classified into midterm (3-5 years) and long-term (6-8 years) observation groups. The trials are based on the standardized ARO-Questionnaire of the knee joint, the modified ARO Knee-Score and the radiological grading according to Larsen, Dale and Eek. In the prospective clinical trial we found significant better results for patients treated with the combined therapy than for patients treated with radiation synovectomy only regarding the parameter swelling, effusion, range of motion, pain and Knee-Score. In the long-term results of the retrospective clinical trial the patients treated with the combined therapy showed a significant better outcome for the parameters pain, swelling and Knee-Score, than the patients treated with radiation synovectomy. Although no statistically significant difference was found comparing the results of the combined therapy with arthroscopic synovectomy, an improvement of the clinical outcome can be observed performing arthroscopic synovectomy followed by radiation synovectomy. In the treatment of rheumatoid arthritis of the knee joint a better outcome is achieved performing combined arthroscopic and radiation synovectomy than performing only one of the methods.

Arthritis, Rheumatoid↗
PubMed1998

[Acetabular reconstruction using acetabular reinforcement rings].

Reviewing the literature the revision arthroplasty of the hip joint with acetabular reinforcement rings shows good results concerning a follow-up period of six years in comparison with cemented or non-cemented primary implants. We use different acetabular reinforcement rings with differentiated indications. The primary assignment is the secure fixation of the ring to the vital bone. The acetabular bone defect is filled with autogenous or homogeneous bone grafts. The increasing number of massive acetabular defects made us develop a new acetabular reinforcement ring. It allows a better fixation than the Burch-Schneider Ring and is cheaper than the individual acetabular implant. Since 1988 we performed 262 revision arthroplasty with acetabular reinforcement rings. Until 1996 we evaluated 174 reinforcement rings (41 Müller rings, 72 Ganz rings, 41 Burch-Schneider rings, 6 RS or RSH ring, 5 individual acetabular implants). After an average follow-up period of 5.6 years a radiological or clinical loosening of the acetabular component occurred in only 6 patients (3.4%). To reach a better comparison of the surgical results we developed a score, which differentiate checks the operative goals. On plane pelvic radiographs we checked the reconstruction of the rotation center, the demarcation of the acetabular component and the outcome of the bone transplant.

Acetabulum↗
PubMed1998

Frozen shoulder--an algoneurodystrophic process?

The frozen shoulder syndrome and the Sudeck syndrome are clinically in many aspects similar. Radioisotope bone scan shows an increased uptake in the affected areas in both diseases, while standard radiographs show a progressive demineralization. With measurement of bone-mineral density by quantitative digital radiography these local decalcification processes were diagnosed in an early stage of the frozen shoulder syndrome: of 12 patients with primary frozen shoulder 10 had a bone-mineral density decrease of more than 21% in the humeral head of the affected shoulder compared to the unaffected side. In the control groups (n = 32) the difference between affected and unaffected side (left and right humerus of the healthy probands) was in only one case each above 21%. There are several indications in the literature assuming the frozen shoulder to be an algoneurodystrophic process. Our observation supports this hypothesis, and may possibly lead to earlier diagnosis and improved therapeutic management.

Bone Density↗
PubMed1996

[The rheumatic forefoot].

The prevalence of rheumatic forefoot arthritis is estimated at 85-95%. Early synovitis of the metatarsophalangeal (MTP) joints is frequently neglected or overlooked. The disease leads to depression of the forefoot arch, dislocation of the MTP joints and hallux valgus with severe metatarsalgia. Operative treatment may give good results in 77-91% of cases. Our preferred treatment consists of resection arthroplasties for the smaller toes and use of Swanson spacer for the big toe, extensive capsular and tendon release from the dorsal approach, reduction of the first metatarsal bone, relocation of the extensor hallucis tendon and postoperative corrective dressing for 6-12 weeks. With this technique, we obtained 36 good results out of 46 forefoot reconstructions, the mean observation period being 30 months.

Adult↗
PubMed1988

[Surgical therapeutic possibilities of the elbow in chronic polyarthritis].

The natural history of rheumatoid arthritis of the elbow often includes impairment of the function of the upper extremity in advanced stages of the disease. Synovectomy performed by a large radial incision is considered a worthwhile procedure for stages 1-3 according to the classification of Larsen et al. Radiosynoviorthesis is possible in stages 0 and 1. In the authors' opinion, resection- and interposition arthroplasty remains the procedure of choice for advanced stages 4 and 5. For elbows with severe instability alloarthroplasty may be considered. The radial head should generally not be resected. Entrapment neuropathy of the ulnar and the posterior interosseus nerves is possible in rheumatoid arthritis patients. The surgical treatment consists in decompression, if necessary with transposition and synovectomy of the elbow joint.

Arthritis, Rheumatoid↗
PubMed1987

[Personal experiences in surgical treatment of chronic instability of the anterior knee joint].

The results achieved with three different operative methods for the treatment of chronic anterior instabilities of the knee joint are presented. In 23 patients Trillat's modification of the O'Donoghue procedure was performed to reconstruct the medial collateral ligaments and the posterior capsule. Thirteen patients underwent reconstruction of the cruciate ligament with a free graft of the patellar ligament according to the Brückner method. In 37 patients the Brückner method was used for cruciate ligament replacement combined with lateral repair according to Ellison, and in some of these patients the posteromedial portion of the capsule was also reconstructed. Seventy-three patients (87.9% of all operated cases) were followed-up. The average observation period was 2.9 years and the mean age at the time of operation was 33.1 years. Major meniscal lesions were noted in 42 patients (57.5% of the cases). Twenty patients presented with combined instabilities or anteromedial grade II instabilities preoperatively. The majority of cases (53 patients) exhibited complex instabilities or anteromedial grade III instabilities preoperatively. At follow-up the Lachmann test was negative or trace-positive in 11 patients (48%) of group I, in 9 patients (69%) of group II, and in 34 patients (92%) of group III. Other stability tests, such as the pivot shift test and the drawer test, confirmed the superiority of group III. The overall results--considering both objective and subjective factors--showed good to excellent results in 12 patients of group I (52%), in 8 patients of group II (62%), and in 31 patients of group III (84%). We therefore conclude that combined and complex instabilities are indications for surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

[Aseptic necroses of the carpal bones].

The most frequent aseptic necrosis in the carpal area is Kienböck's disease, followed by necrosis of the scaphoid and capitate. Necrosis of carpal bones are seen after different conditions as chronic traumatism, cerebral palsy, chemotherapy, as well as deficient vascularisation of the carpus. Varietys of the wrist joint anatomy may contribute to development of Kienböck's disease. The natural course of the disease shows progressive necrosis and bone destruction in adults. However the clinical symptomatology may show a higher degree of variation. Prevention of carpal dissociation seems to be important. Early surgery by vascularisation techniques and retention of the necrotic bone are indicated. In stages III and IV with collapsing deformity, resection-interposition arthroplasty using autologous material, or silastic spacers, have proven to be successful.

Arthrodesis↗
PubMed1985

Therapeutic effect of cryosurgery of murine osteosarcoma--influence on disease outcome and immune function.

Experiments comparing conventional operative treatment and cryosurgery of a murine osteosarcoma showed that local tumor destruction by freezing in situ was similar or superior to amputation concerning survival and formation of metastasis, depending on tumor stage. Limited local resection was less effective. Immune functions affected by cryosurgical tumor destruction included depression of natural killer cell activity and decrease of tumor-specific autologous IgG antibodies in the serum.

Animals↗