[Fractures occurring following and during insertion of hip and knee prostheses].
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Biomedical subjects
Publications and source records attributed to M Jäger.
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A new femur distractor has been developed, lengthening the leg. This instrument is electronically controllable and can be implanted totally. It is possible to regulate transcutaneously by radio control the operation "forward motion", "stop" and "backward motion". After testing this instrument in sheep, the lengthening of human femur by this system can be introduced.
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A new femur distractor for operative leg lengthening has been developed. The new instrument consists of an electronically controllable distractor set including a power unit and a two-part guide rail. The whole system can be implanted totally and gives rigid fixation throughout the period of distraction. The operations "forward motion", "stop" and "backward motion" can be regulated transcutaneously by radio control. A prototype especially developed for animal experiments has been tested successfully in sheep.
The increase of knee lesions within the last years has provoked a generally more intensive discussion about the functional anatomy, the biomechanics and the pathophysiology of the capsule and ligaments of the knee joint. Several authors have stressed the importance of the active and passive factors, stabilizing the knee joint. The injury to a single element leads to different instabilities, as proven by meticulous clinical and radiological diagnostic procedures. The progress in the treatment of fresh and old injuries of knee ligaments is connected with the names of O'Domoghue, Slocum, Larson, Hughston, Nicholas and Trillat. For a fresh completely ruptured ligament surgery is recommended. Torn menisci are reattached whenever possible. An initial graft can be necessary for ruptures of the anterior cruciate ligament. Complex injuries, which are found most frequently, have to be dealt with completely. Old injuries of capsule and ligaments may require a plastic reconstruction. For the reconstruction of the anterior cruciate ligament it has been proven useful to take distally attached tendons of the pes anserinus group as well as the free graft from the central 1/3 of the patellar ligament. Rotational instabilities have to be dealt with according to the type of instability. The techniques of Slocum and Larson and the "five in one" reconstruction by Nicholas have to be emphasized as treatment of the anteromedial rotational instabilities. McIntosh has shown a procedure which seems to be successful for anterolateral rotational instabilities. Several techniques have been compared with our own experiences and late results studied. The point is stressed that further progress has to be made for the treatment of injuries to ligaments of the knee.
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To an increasing extent the total replacement of a hip joint damaged by disease or trauma is increasing in importance. Yet the implantation systems in use at the present time show defects which lead to increased rates of reoperation. In particular, the reactions at the implantation-tissue limiting surface must be specially mentioned. A number of technical parameters are therefore discussed which arise as possible causes for prosthesis clearance.
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To evaluate the presence or absence of hepatic metastases or primary hepatoma 106 patients were examined by liver scintigram as well as laparoscopy or laparotomy. A definite diagnosis was established in all patients by histology, autopsy or observation of clinical course for at least one year. Only scintigrams resulted in false positive diagnosis (in 5%). False negative diagnoses were obtained in 29% of laparoscopies and in 36% of scintigrams when evaluated routinely with knowledge of the clinical findings and laboratory examinations. Analysis of the same scintigrams by an experienced examiner without knowledge of the clinical findings lowered the proportion of false negative scintigrams to 12%. In 5 patients with liver metastases or hepatoma coexisting in liver cirrhosis or advanced chronic liver congestion, both methods of examination gave false negative results.
37 R.A. patients who had been operated on several times (synovectomy and reconstructive surgery) were re-examined within 1 to 6 years after operation. Pain and function were improved in 2/3 of the patients, morning stiffness, ESR, and medicine consumption decreased in 2/3. The lower cortisone requirement in 28 patients (75%) was particularly impressive. 25 patients (67%) became cortisone-free. The joint index was reduced in 30 patients (81%). The impression exists that the rheumatic process can be influenced surgically for a long time.