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Biomedical subjects

L Lidgren

Publications and source records attributed to L Lidgren.

At least 109 records · Page 6Linked to original sources
PubMed1984

Comparison between hemiarthroplasty and total hip replacement following failure of nailed femoral neck fractures focused on dislocations.

The frequency of and the factors causing dislocations of 71 total hip replacements and 59 hemiarthroplasties following failure of nailed femoral neck fractures were investigated. Dislocations were frequent and occurred in four (6%) and seven (l2%) hips respectively. Malposition of the components increased the risk for dislocation. A well-positioned total hip replacement was more stable than a hemiarthroplasty.

Aged↗
PubMed1984

Contamination of irrigation solutions in an operating theatre.

Sterile irrigation solution, used in open systems in a conventional orthopedic operating theatre, were examined for bacterial contamination. At the end of 13 of 21 operations (duration greater than or equal to one hour) the solution tested displayed the growth of Staphylococcus epidermidis and/or diphtheroid rods and/or other species. It is concluded that irrigation by solutions, kept in open bowls during an operation, is a potential source of contamination.

Acinetobacter↗
PubMed1984

Surface replacement of the elbow in rheumatoid arthritis. Early results with the Wadsworth prosthesis.

Fifteen patients with rheumatoid arthritis had 19 elbow arthroplasties with the Wadsworth type of surface replacement prosthesis. After a follow-up period averaging 30 months, 11 patients with 15 elbow arthroplasties were entirely satisfied with their freedom from pain and range of movement. Radiologically, however, the humeral component was loose in 10 of the 19 elbows and the ulnar component in 5. Two patients had reoperation, one to remove a prosthesis for early deep infection and one to exchange a humeral component which was loose. The risk of mechanical loosening is reduced by accurate positioning of the humeral component, but there is a high potential for failure. Changes in the design of the prosthesis and better instrumentation for alignment of the components are desirable. Prosthetic replacement of the elbow should still be regarded as experimental.

Adult↗
PubMed1984

Cefuroxime in acute septic arthritis.

Cefuroxime was used in 17 patients with clinical, bacteriological and/or laboratory signs of acute septic arthritis in comparison with 10 patients given cloxacillin and ampicillin alone, or in combination. 14 patients in the study group had positive cultures (Staphylococcus aureus, 10, S. epidermidis, 1, Streptococcus pyogenes group G, 2 and Acinetobacter, 1). Three more patients with non-bacterial arthritis were included in an antibiotic penetration study. In 6 patients serum and joint fluid concentrations of cefuroxime were repeatedly determined by an assay using high pressure liquid chromatography. After 1.5 g intravenous cefuroxime the joint fluid concentrations were 16-80 and 5-40 mg/l at 2 and 8 h, respectively, exceeding the serum concentrations during that period of time. From the clinical and pharmacokinetic data a dosage of 1.5 g cefuroxime intravenously t.i.d. is recommended to the adult patient. This high dosage resulted in primary healing in 11 patients with one relapse one year later in a patient with a knee arthroplasty. Half the dosage intramuscularly in 6 patients failed in 2. No side effects were seen during cefuroxime therapy.

Acinetobacter Infections↗
PubMed1984

Seventy-four Attenborough knee replacements for rheumatoid arthritis. A clinical and radiographic study.

Seventy-four Attenborough total knee replacements in patients with severe classical rheumatoid arthritis were followed for 2-5 years. The preoperative radiograms were evaluated according to two different scoring systems. At follow-up, radiographic whole leg examinations were performed. Mean malalignment was 7 degrees. The overall results were not encouraging with definite failure in eight knees and probable failure in another 21 knees. Failure was significantly correlated with postoperative malalignment.

Adult↗
PubMed1984

Complications after trochanteric fractures. A comparison between Ender and nail-plate osteosynthesis.

Three hundred and forty-one trochanteric femoral fractures operated with intramedullary nailing (Ender) or nail-plate osteosynthesis (McLaughlin) were followed up for 4 months and reoperations were recorded at 18 months. Both methods had an unacceptably high frequency of complications, radiographically in one third and reoperations in one tenth of the total material. The greatest number of operative technical problems was encountered in the Ender group. The 4-month radiographic follow-up showed more complications in unstable than in stable fractures for both methods. In stable fractures, the Ender group had more radiographic complications. There was a slightly better walking capacity at 4 months and fewer reoperations at 18 months in the McLaughlin group.

Bone Nails↗
PubMed1984

Total hip replacement with spongious bone graft for acetabular protrusion in patients with rheumatoid arthritis.

Total hip replacement (THR) with the use of autogenous spongious bone graft reinforcement to the medial acetabular wall proved a successful surgical procedure in patients with rheumatoid arthritis and acetabular protrusion. In 25/26 THR followed for an average of 2 (1-4) years, the bone grafts healed in place radiographically and no further protrusion occurred. A non-progressive radiolucent zone of 3 mm at the bone-cement interface occurred around one acetabular cup. Recurrent dislocations occurred in one hip, which eventually turned out to have a loose acetabular cup. One hip with a firmly seated cup was converted to a resection arthroplasty 4 months after the primary operation because of deep infection.

Acetabulum↗
PubMed1984

Strength of polymethylmethacrylate increased by vacuum mixing.

The mechanical strength of high and low viscosity gentamicin-containing cement was analysed using three different mixing procedures: hand, vibration, and vacuum stirring. Vacuum mixing improved the flexural and compression strength and the modulus of elasticity by 15-30 per cent, especially for high viscosity cement.

Bone Cements↗
PubMed1984

Arthrodesis after failed knee arthroplasty. A nationwide multicenter investigation of 91 cases.

Ninety-one patients with attempted arthrodesis after failed knee arthroplasty were identified in a prospective nationwide study of knee arthroplasties performed from October 1975 through January 1982 in Sweden. The study included 43 hinged or stabilized, 34 bi- or tricompartment, and 14 unicompartment endoprostheses. Three-fourths of the failures were caused by infections. At follow-up evaluation, two patients had expired from infection and four patients had amputations. Fusion was achieved in only 50% of 108 attempts in 91 knees. Patients with unstable joints had limited function. The fusion rate was relatively high after unicompartment endoprostheses, in cases with sustained rigid fixation, or in cases where infection was brought under control at arthrodesis. Rigid fixation was best achieved with an external double frame or an intramedullary nail. Repeated attempts were worthwhile. Removal of all foreign material, eradication of the infectious lesion, and an arthrodesis performed in a one- or two-stage procedure with insertion of gentamicin beads seemed to be the best way to combat infection. The treatment of prosthetic failures should be referred to centers with special interest in knee arthroplasty.

Adult↗
PubMed1984

Stability of external fixators used for knee arthrodesis after failed knee arthroplasty.

Secondary arthrodesis as treatment for failed knee arthroplasty is being used increasingly. The usual method is sustained rigid external fixation. The fusion rate is low in cases with considerable metaphyseal bone loss and poor bone quality. Currently, the Hoffmann- Vidal fixator or comparable designs are preferred to the less stable Charnley single frame fixator. The standard Hoffmann- Vidal device uses only transverse percutaneous fixating pins and gives an anteroposterior bending stiffness that is considerably lower than the lateral bending stiffness. In the present study, external fixators were tested for stability in a material testing machine under standardized conditions using synthetic bones. The anteroposterior bending stiffness was significantly improved when sagittal pins connected to a ventral compression rod were added to a Hoffmann- Vidal fixator. Stiffness was still more improved when sagittal pins were connected to ventral frames as in a modification of the Hoffmann- Vidal or the similar Ace-Fischer fixator.

Arthrodesis↗
PubMed1983

Nerve palsy after knee arthroplasty in patients with rheumatoid arthritis.

Forty-two consecutive knee arthroplasties on rheumatoid knees (19 Attenborough, 20 Total Condylar, 3 Marmor) were examined pre- and postoperatively for signs of below-the-knee nerve lesions. Sixteen of these knees were also studied neurophysiologically (EMG). Four patients (knees) had peroneal nerve palsy, three early and one late. Three further knees had only EMG signs of nerve lesion. Predisposing factor was correction of flexion contracture of more than 10 degrees and especially when combined with varus change in alignment. Preoperative EMG could not predict nerve lesion.

Action Potentials↗
PubMed1983

Soft tissue release of the hip in juvenile chronic arthritis.

Adductor and/or subspinal tenotomies were performed on 17 patients (25 hips) with longstanding juvenile chronic arthritis and hip disability. The flexion contracture decreased after surgery from 28 to 18 degrees but had increased to the preoperative level by an average follow-up time of 48 months. The adductor contractures followed the same pattern. All but 3 of the patients were dissatisfied with the relatively small gain and the short-lasting effect of the operation. Knee contractures and insufficient release are probably some of the reasons for the poor results. A more extensive release is recommended and in the case of hip pain combined with synovectomy.

Adolescent↗
PubMed1983

Incidence and stability of trochanteric femoral fractures.

Sex, age and stability were recorded in 376 cases of trochanteric femoral fractures. In 168 cases the age and sex specific incidence was determined. When comparing our results with those in previous studies from the same region there was no increase that could not be related to age. This is in contrast to other reports from Scandinavia where investigators have found an increase in fracture incidence that could not be explained by the increasing number of old people. We, as others, have found a high proportion of unstable fractures. The unstable fractures did not occur more frequently in the oldest age groups.

Adult↗
PubMed1983

Total hip replacement in juvenile chronic arthritis.

Fifty total hip replacements in 33 patients with juvenile chronic arthritis were performed over a 10-year period with good pain reduction, increased hip motion but only a moderate increase in walking capacity. The average age at operation was 26 years and the average follow-up time 77 months. Six hips (patients) have been reoperated, one for infection, one for suspected infection and four due to mechanical loosening. Loosening was revealed radiographically in 10 hips at follow-up. Lack of cement cover and varus position was the main reason for loosening of the femoral stem. Considering the high loosening rate it is probable that at least one revision arthroplasty will be necessary in the future.

Adolescent↗
PubMed1983

Synovectomy in bacterial arthritis.

Twenty patients with bacterial arthritis with either delay in diagnosis or no response to treatment are presented. Synovectomy, even when performed after 5 days and up to 4 weeks later, could prevent joint destruction in the knee but not in the hip. The average follow-up time was 5 (2-9) years.

Adolescent↗
PubMed1983

Total hip joint arthroplasty with gentamicin-impregnated cement. A clinical study of gentamicin excretion kinetics.

The excretion pharmacokinetics of gentamicin (GM) following total hip joint arthroplasty with GM-impregnated bone cement were studied in ten patients. The patients received 0.5-1.1 g of GM. Twenty-four-hour portions of urine were collected for up to 60 days after operation. GM concentrations in urine were initially 8-25 mg/l, and during the first four days the excretion ranged from 0.7 to 25 mg/day. On the 30th day drug levels in the urine were 0.5-1.0 mg/l, and the excretion was 0.5-1.0 mg/day. The GM excretion-time curve consisted of an initial rapid phase that terminated four to six days after operation, with a half-life of 0.65 days, and a slow phase with a half-life of 7.5-73.0 days (mean, 16 days). From the area under the excretion-time curve and from extrapolation of the registered terminal phase, it was calculated that 5%-18% (mean, 13%) of the GM administered was accounted for. Thus, a major portion of the drug was unaccounted for. Data obtained two years after operation suggested that the half-life of the terminal phase is much longer (greater than 240 days) than that calculated from data obtained during the first two months after operation. It was calculated that the surface area of the cement would be in excess of 150 cm2 and that the volume of an interface tissue layer 1 mm thick would be approximately 15 cm3. Thus, at three weeks, when the daily excretion was approximately 1 mg/24 hours, 67 micrograms/cm3/day of GM would be available for antimicrobial action at a tissue--cement interface 1 mm thick.

Adult↗