Biomedical subjects
Publications and source records attributed to F R Voss.
Limb salvage after infection and multiple knee revision arthroplasty is difficult. The treatment options and a brief history of artificial fusion are reviewed, and a case with 4-year follow-up is described.
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UNLABELLED: A histological study was performed of the bone-implant interface of fifteen titanium-alloy femoral stems with porous coating limited to three proximal areas that did not cover the full circumference of the device. The specimens were obtained at autopsy from ten cadavera at a mean of forty-six months (range, one to eighty-nine months) after the implant had been inserted without acrylic cement. The volume fraction of bone within the porous spaces (the percentage of the porous space that was filled with bone) and the extent of bone ingrowth (the percentage of the porous-coated surface covered with in-grown bone that was more than one-half fiber-diameter deep, as measured from the outer surface of the porous coating), were determined with histomorphometric methods. Eleven of the fifteen stems had bone within the porous coating that was in continuity with the surrounding medullary bone. The mean volume fraction of bone ingrowth in these specimens was 26.9 per cent (range, 12.2 to 61.0 per cent), and the mean extent of bone ingrowth was 64.3 per cent (range, 28.6 to 95.2 per cent). Both of these parameters increased with time. In the other four stems, the bone lacked continuity with the surrounding trabecular bed. Two of these stems had a limited amount of bone within the porous coating, and two stems (from one patient) had no bone ingrowth. Periprosthetic membranes surrounded by a shell of trabecular bone covered the uncoated surfaces of the stems. The membranes of implants that had been in situ for eight months or more demonstrated polyethylene wear debris, and other particles generated at the level of the joint, within histiocytes throughout the length of the femoral stem. CLINICAL RELEVANCE: The findings in this study are relevant to the utilization and mechanisms of failure of femoral stems inserted without cement. Bone ingrowth and the resulting stability of the implant can be achieved with porous-coated stems. However, the extent of the surface that is porous-coated must be sufficient to prevent trabecular fracture as a secondary mechanism of loosening. Interruptions in the circumferential extent of the porous surface are associated with the formation of periprosthetic membranes, which provide a pathway for migration of particulate wear and corrosion products to the distal part of the stem. A circumferential coating may retard the access of particles and thus decrease the possibility of diaphyseal osteolysis.
Between 1974 and 1989, a lateral closing wedge osteotomy was used to correct posttraumatic cubitus varus in 36 patients. In 35 (97%) of the patients, the deformity was corrected to within 5 degrees of the contralateral elbow, and the patient was satisfied with the result. There were no nerve palsies or infections. Of the nine patients treated before age six years, seven had a minimum 2-year follow-up (average 9 years), and there was no evidence of recurrent deformity. This technique allows good correction of deformity with minimal complications.