Indications for radical resection of malignant bone tumours. Results in forty-six cases.
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Adolescent↗
Biomedical subjects
K Knahr
Publications and source records attributed to K Knahr.
[Personality tests done by the "Freiburg Personality Inventory" on patients after leg amputation (author's transl)].
47 patients after leg amputation were investigated by the "Freiburg Personality Inventory" (FPI). Results showed that the personality structure of these patients corresponds to that of the normal population.
Adolescent↗
Resection of malignant bone tumors.
Amputation is an unsatisfactory and depressing measure for the patient as well as for the surgeon. As long as operative removal of tumors in the extermities is indicated, the search for alternative solutions should be the most urgent task for every doctor involved in surgery. Resection would be the most equitable measure as far as demands for radicality and the best possible restoration of function are concerned. In order to warrant the radicality of the operation, meticulous preoperative planning and precise surgical techniques are essential. Sufficient restoration of function must take into consideration all the factors of the individual case, age and profession of the patient playing a large role. After partial resection of longer tubular bones, fitting of an endo-prosthesis has proved to be advantageous. Implants available at present have various drawbacks; studies directed at the elimination of these drawbacks must be set up.
Adolescent↗
[Atypical amputations of bone tumors of the lower extremity (author's transl)].
The most predominant problem concerning malignant tumors in the lower extremities is the radical removal of the tumor, for this almost always involves amputation. Referring to the eventual outfitting of a prosthesis one must keep functionality in mind from the start. This includes all the planing for the preservation of a stump that can be fitted with a prosthesis. Experience has confirmed the advantages of foot-root stumps and knee disarticulation. Good functional results can be attained with tumors of the femur in individual cases through atypical operations. This involved elongation of the stump by means of a fibula transplant; replacing the femur with a bioceramic endoprosthesis; and rotation-plasty, whereby the knee joint is replaced by the ankle joint.
Adolescent↗
[The consideration of footforms for a better judgement and explanation of footcomplains (author's transl)].
Differentiating individual foot types has decisive advantages in diagnosing and treating fallen arches and splayfoot. The basic methods of classifying different foot types are discussed and the necessity of such classifying is shown. Seemingly different interpretations of foot malformations are thereby explicable. Reference is made to the problem of therapeutic failures resulting from non-observance of the interaction between the arch-support and the shoes worn. The positive effects of indicated alterations in heel height are demonstrated.
Flatfoot↗
[Endoprostheses for primary or secondary malignant tumors of bone at the proximal end of femur (author's transl)].
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Adolescent↗
[Gonarthrosis and empyema in geriatric patients. Combined synovectomy and KTEP implantation procedure].
ISSUE: Is a one stage procedures with open synovectomy and implantation of cemented knee endoprostheses in patients with empyemas of the knee and concomitant osteoarthritis suitable to reduce morbidity and increase early mobility? METHOD: Three female patients (age [symbol: see text] 88 yrs.) with acute empyema of arthritic knee joints (Pathogen: Staph. aureus) were treated with open synovectomies and implantations of cemented TKA's in a one stage procedure at mean 3 days (1-6) after admission. After 4.6 months (3-6) we carried out the last clinical and radiographic examination and after 15 months (11-21) a telephone questionnaire. RESULTS: The mean operation time was 2.4 hrs. (2-3), the perioperative blood loss at mean 1040 cc (800-1180 cc) and patients received 4 units blood (4-5). Parenteral antibiotics were administered for at mean 21 days (18-25 d). 33 days (27-39) after surgery the patients could be discharged, all of them ambulated with a walker, the operated joints had no signs of infection and blood parameters i.e. leucocyte count, crp and ESR dropped. At the time of the latest follow up examination there were neither clinical nor radiographic any signs that infections recurred. Two patients ambulated with crutches, one still with a walker. The HSS-Score increased from preop. 54 pts. up to 80 pts. at the follow up. CONCLUSION: Due to our results, a one stage procedure with open synovectomy and implantation of cemented total knee endoprostheses seems to be a considerable alternative for the treatment of geriatric patients suffering from knee empyema and severe osteoarthritis.
Aged↗
[Quality of life five years after total or partial knee arthroplasty].
AIM: Multiple aspects of health-related quality of life were assessed in elderly patients after total or partial knee arthroplasty. METHOD: 187 subjects who had undergone knee arthroplasty 5 years ago were asked to fill out 3 questionnaires, the Nottingham Health Profile, the SF-36 Health Survey and the Funktionsfragebogen Hannover. Results were compared to standard data. The impact of gender and age was analyzed, and 3 different types of prostheses were compared. RESULTS: Response rate was 74 % (n = 138). Regarding the main symptoms pain and subjective function, as well as almost all other aspects, quality of life proved to be significantly reduced compared to the age-matched general population. Correlations between age and quality of life scales were low. Different types of implants led to similar results in all scales but one. CONCLUSION: 5 years after knee arthroplasty the quality of life is markedly reduced compared to the general population. The impact of age, gender, and type of implant is low. In our sample, the SF-36 showed methodological advantages compared to the NHP for the measurement of subjective pain and function.
Activities of Daily Living↗
[Peripheral nerve lesions after total hip endoprosthesis].
AIM OF THE STUDY: Lesions of peripheral nerves are serious complications associated with total hip replacements. Prognostic factors and treatment concepts have not been sufficiently defined. Improvements can occur spontaneously. This study aimed to evaluate risk factors and diagnostic aids, such as the velocity of nerve conduction (VNC) and electromyography (EMG). Furthermore, the effect of prognostic factors as well as conservative and invasive therapeutic measures on the regression of clinical symptoms was examined. METHOD: From 1990 to 1996 1833 patients underwent total hip replacement. 1447 procedures were primary total hip replacements and 386 were revisions. 14 femoral nerve lesions (0.8%), 7 sciatic nerve lesions (0.4%) and 8 peroneal nerve lesions (0.4%) occurred. 19 patients were examined clinically, electromyographically and by means of VNC, 10 patients only clinically. In 5 patients a neurolysis was performed within the first postoperative year. All 29 patients underwent a recall examination in 1997 to evaluate the development of the clinical symptoms and if possible, VNC and EMG were performed. RESULTS: Of the 7 patients with sciatic nerve lesions, two were free from symptoms at the time of recall, two still complained about residual symptoms and two showed no improvement of the lesion. One patient did not appear for follow-up. Of the 8 patients with peroneal nerve lesions, five were free from symptoms at the time of their recent examination, two showed residual symptoms and one patient did not appear. Of the 14 patients with femoral nerve lesions, four had recovered completely, eight showed residual symptoms, one patient did not improve and one patient had died. CONCLUSIONS: Prognostic statements regarding the improvement after nerve lesions are possible only to a limited degree. However, it was found that the motor function tended to recover earlier than sensibility. We could not determine with clinical evaluations why some patients showed an improvement of their lesion while others did not. As well no clear correlation between the EMG and VNC results and the recession of the symptoms could be established.
Adult↗
[Psychological adjustment to invasive surgical and medicamentous tumor treatment of osteosarcoma patients with rotation-plasty].
Ten patients with osteosarcomas and rotation plasties made themselves available for a psychological survey. The time elapsed after their operations was between two and ten years, giving an average of six years. All patients were free of tumours at the time of the follow-up examination. Both in personal interviews and in psychological tests, it was possible to observe a very positive development of these patients' attitudes. Contributory factors in this context were discussions with the doctors administering treatment, the cheerful atmosphere of the hospital and the nursing staff, the physicotherapists and ergotherapists, and the excellent social support which all those interviewed also received from their relatives. Continuous positive motivation, a favourable social dialogue and patients' ability to control their own lives would appear to be the key factors in helping patients to come to terms with their illness.
Adaptation, Psychological↗
[Prognosis of hip endoprostheses after disorders of wound healing].
41 draining sinuses after THR were treated by debridement without exchanging the implants. Positive bacterial cultures were obtained in 23 patients-the ilio tibial tract was found open in 19 cases (82%). The bacterial cultures were negative in 18 patients-the ilio tibial tract was found open in 7 cases (38%). Revisions took place 21 days (9-43) after primary implantation. At the time of the follow up (0 72 months postoperatively) 7 patients had been revised (8-97) because of recurrence of infection. The results of debridements of contaminated sinuses depend on the ilio tibial tract. Revisions were successful in three out of four paces with an intact, and only in eight out of nineteen cases with an open ilio tibial tract. Besides proper bacterial investigation preoperative sinograms give useful information about the prognosis of revision. In cases with positive bacterial cultures debridements should be done very early to eradicate infection without removing the implants.
Aged↗
[Results of medullary space decompression in the early stage of so-called idiopathic femur head necrosis].
The results of 47 cases of core decompression in 42 patients with stage I and stage II (according to Ficat) avascular necrosis of the femoral head who had been followed up for a minimum of two years were subjected to retrospective analysis. All these cases involved so-called "idiopathic necrosis" of the head of the femur including patients with risk factors (alcohol abuses, lipometabolic disorders and hyperuricemia). 87% of the 30 stage I hip joints showed no radiological signs of deterioration and could also be classified as clinically successful (average follow-up time 47 months (24-100 months). After an average follow-up period of 38 months (24-86 months), 41% of the 17 stage II hip joints had to be classified radiologically as failures. A good clinical or radiological result could be achieved in 59% of these cases. This procedure has proved to entail low risk, and can be recommended as the first choice of therapy at early stages of necrosis of the head of the femur.
Adult↗
[Surgical treatment of a bunionette].
The term Bunionette or Tailor's Bunion is applied to an abnormal prominence on the lateral aspect of the fifth toe similar to the Hallux valgus of the first ray. Several different operative procedures-proximal, diaphyseal or distal-are advocated. Our analysis compares the clinical and radiological results of the distal oblique osteotomy and the distal Chevron metatarsal osteotomy. The clinical evaluation is based on the "Mayo Clinic Forefoot Scoring System" (max. 75 points). Radiographic examination includes measurement of the fourth to fifth intermetatarsal angel, the fifth metatarsal phalangeal angel, as well as the shortening of the fifth metatarsal ray. Overall clinical results were evaluated as very good in both surgical techniques, all the patients obtained more than 70 points in the score. The radiographic analyses show an improvement of the "functional angels" (IMT IV-V, MTP V) with both osteotomies. In all the cases of the distal oblique osteotomy there was a shortening of the fifth metatarsal bone and sometimes a tilting of the head with a consecutive "malalignment" of the metatarsal row without clinical impairment. The Chevron procedure resulted in correct positioning of the metatarsal head in all patients.
Adolescent↗
[Follow-up analysis of total hip endoprosthesis after femoral neck fracture with and without previous operation].
Damage occurring after joint-preserving surgical treatment of femoral neck--mostly femoral head necrosis of pseudoarthrosis-necessitates endoprosthetic joint replacement. In the case of inferior bone quality and unfavorable fracture forms as well as after failed conservative therapy, surgical treatment consists of implanting a total hip endoprosthesis. Between 1971 and 1989, 120 patients received total hip replacement after suffering fractures of the femoral neck: 61 patients did not have previous surgery, 59 patients had had joint-preserving surgery. Statistical analysis of the results showed that the primary stabilizing operation to preserve the joint did not have a negative influence on the survival probability of the total hip replacement in comparison with primary implantation. If the joint-preserving primary intervention fails, total hip replacement is a good choice for secondary surgery. In the case of complications such as femoral head necrosis or pseudoarthrosis the indication for total hip replacement should therefore be made early on.
Aged↗
[Long term results of the Keller-Brandes method of hallux rigidus surgery].
Between the years 1971 and 1975 a surgical treatment of hallux rigidus according to Keller Brandes was performed on 293 patients. From 100 patients with 137 operated feet a clinical and roentgenological examination was evaluated 12 to 16 years after surgery. The subjective assessment showed in 92% of the feet very good or good results. Important for the success of the operation is the correct amount of bone removal of the proximal phalanx (between 1/3 and 1/2) and the resultant width of the nearthrotic joint space. The analysis of the podographic examination and the amount of retraction of the sesamoids showed no correlation to the incidence of postoperative metatarsalgia, which we found in 31 feet (29%). Nevertheless, X-Ray Evaluation of all patients with metatarsalgia showed a posterior shift of the sesamoids.
Adult↗
[Prevention of ossification after total hip endoprosthesis with indomethacin and its effect on gastric mucosa].
The administration of indomethacin as a prophylactic against heterotopic ossification following the implantation of total hip-joint endoprosteses entails the risk of gastrointestinal side-effects. A prospective randomized study set out to determine the effectiveness of ranitidine and sucralfate as a secondary treatment for the protection of the stomach. Comparison with a placebo group monitored at the same time confirmed the efficacy of both medicaments. Both ranitidine (2 x 150 mg) and sucralfate (4 x 1 g) were able to prevent the occurrence of ulcers of the mucous membrane of both stomach and duodenum. Thanks to postoperative prophylactic treatment with indomethacin (2 x 50 mg for 3 weeks), there were no serious ossifications (degree II or III according to Arqu).
Adult↗
[Long-term analysis of cement-free implanted PCA knee endoprostheses with 5-8 year follow-up].
A total of 54 PCA knee-joint endoprostheses were followed up over a period of 5-8 years. All the uncemented implants (52 femoral components, 52 patellar components, 54 tibial components) were subjected to radiological analysis of the anchorage zone between prosthesis and bone. The results were evaluated on the basis of the postoperative radiographs and the follow-up radiographs, which were divided into four groups. It was necessary to create a 5th group for radiographs not suitable for evaluation. The use of fluoroscopy is therefore essential in order to ensure that all radiographs can be evaluated. The best results were obtained with the uncemented femoral prosthesis. Complete "incorporation" with close contact between prosthesis and bone was observed in all cases, even if implantation was not optimal. Radiological loosening of the uncemented patella occurred in 3 patients, and it was necessary to perform one patellectomy 6 years postoperatively. In the case of the tibia implant, the follow-up showed radiological "incorporation" of the prosthesis in all cases with technically adequate implantation: the tibia implant was inadequately implanted in 8 cases. Radiological loosening of the tibia implant was observed in 4 of these 8 patients. There was a higher rate of radiological failure in the group of patients over 70 years of age, and among patients whose primary disease was primary chronic polyarthritis. However, given technically exact implantation, satisfactory results could be obtained even in these two groups. Clinical pains occurred only several years after evidence of radiological loosening. Radiological follow-up analysis therefore offers a means of obtaining early information about the prosthesis-bone interface of uncemented total knee-joint endoprosthesis.
Aged↗
[5 years' experiences with the Gersthof polyethylene peg-anchored acetabulum].
The acetabular socket "Model Gersthof" is a spheric polyethylene component which can be anchored cement-free by means of three symmetrically arranged pegs at the outside. Between July 1979 and October 1986, 1316 implants of cement-free sockets were performed at our own department. The evaluation of the socket was based on the criterium of radiological instability (= aseptic loosening). After five years of observation, this design-oriented evaluation of success shows a survival of 92% +/- 2.9%.
Acetabulum↗