Biomedical subjects

M Lukoschek

Publications and source records attributed to M Lukoschek.

45 records · Page 3Linked to original sources

PubMedDate not supplied

[Status of cementation technique in total hip endoprostheses in Germany].

AIM: The correlation between improved cementing techniques and improved long-term results after total hip arthroplasty (THA) is well documented. The purpose of this study was to assess the use of modern cementing techniques in Germany. METHODS: A detailed questionaire regarding cement and bone preparation, cementing techniques on actabulum and femur, and implants used was sent to 584 German orthopaedic and trauma hospitals, as well as to visiting surgeons with an interest in THA. In total, 333 questionaires were available for evaluation and statistical analysis. RESULTS: In this survey, Palacos bone cement is used in 84%, low viscosity cement in 9%. Cement chilling is performed in 58%. Mixing is done by hand without vacuum mixing systems in 53%, the mixing time is standardised in 66%. For the femur 83% and for the acetabulum 74% preserve cancellous bone, 13% use pulsed lavage. Cement application is done via cement gun in 97%, in 41% in a retrograde manner and in 18% without drainage of the intramedullary canal. A cement pressurising technique is used in 63% for the femur and in 57% for the acetabulum. A cement mantle of less than 2 mm is attempted in 41%. More than 50 different stem design are implanted with the Müller straight stem being used most often, followed by anatomic designs. Almost 50% of hips are used with a 28 mm head, and almost 50% are implanted with a 32 mm head. Half the heads are ceramic, half are metal. CONCLUSIONS: The results from this survey document, that overall only slightly more than 10% of hips are implanted using second/third generation (modern) cementing techniques with application of pulsed lavage. This has implications on the number of arthroplasties that may require revision. From the data available the current status of cementing technique in Germany cannot be judged satisfactory.

Arthroplasty, Replacement, Hip↗

PubMedDate not supplied

[Complete synostosis of the cervical spine at a young age. A thus far unpublished disease].

A case of complete synostosis of the cervical spine in a 12-year-old girl is described. Differential diagnosis included dysontogenetic forms of synostosis, Klippel-Feil syndrome, rheumatic synostosis and synostosis of other inflammatory origin. This severe case, the first of its type to be described, appeared to be due to tuberculosis of the cervical spine.

Cervical Vertebrae↗

PubMedDate not supplied

[Spinal fractures in ankylosing spondylitis].

In the final stage of ankylosing spondylitis the spine will be completely fixed. With loss of mobility the patients suffering of ankylosing spondylitis are susceptible to spinal fractures. Predominantly the fractures occur in the lower part of the cervical spine, caused often by minor trauma. High fatality is at a 30% rate seen as severe consequence of these fractures. Conservative and operative treatment may be used. Severe fracture dislocation and progressive neurological deficiencies are recommended to be stabilized operatively. To avoid trauma of the spine in patients with ankylosing spondylitis preventive measures seem to be possible and should be employed.

Adult↗

PubMedDate not supplied

[Synovial membrane and cartilage changes in an arthrosis model. Instability and impact stress model].

UNLABELLED: Surgical instability and repetitive impulsive loading was used to generate degenerative changes in knee joints of rabbits. Light- and electronmicroscopy was carried out at synovial membrane and cartilage samples. The instabilised joints had early synovial inflammation, preceding overall cartilage changes. Synoviocytes were activated and showed more and dilatated cytoplasmatic organells. Invaded round cells--potentially cartilage degenerative--were seen. In the loading model no initial synovial inflammation could be seen. Focal cartilage changes were located at the weight bearing zone. Two different inductive pathways may be involved in cartilage breakdown comparing the two arthrosis models. Mechanical factors seemed to trigger cartilage changes in the loading model, an inflammatory synovial pathway is likely to initiate cartilage breakdown in the instability model. CLINICAL RELEVANCE: The synovial membrane has the key-position for the cartilage degeneration in posttraumatic joint affections. The therapeutic use of antiphlogistic substances is indicated to supreme inflammatory mediators from the synovial membrane. This therapeutic concept seemed not to be useful in primary mechanical induced osteoarthrosis.

Animals↗

PubMedDate not supplied

[Periprosthetic mineral density in cement-free hip replacement arthroplasty].

SUBJECT: We analysed the periprosthetic bone mineral density (BMD) in a prospective longitudinal study over two years after operation and in a separate cross-sectional study more than five years after implantation of cementless total hip arthroplasty (CLS-stem, Mecron threaded acetabular cup) by using dual-energy X-ray absorptiometry (DEXA). MATERIALS AND METHODS: In n = 53 patients (29 women, 24 men) we analysed the periprosthetic BMD prospectively in certain periods. All patients had an uncomplicated postoperative course and good clinical outcome (Merle d'Aubigne score > 12). In the cross-sectional study we analysed 23 patients (13 women, 10 men). Regions of Interest (ROI) were defined according to Gruen et al. for the periprosthetic femur and to De Lee and Charnley for the periprosthetic acetabulum. RESULTS: BMD significantly decreases in the periprosthetic femur as well as in the periprosthetic acetabulum during the first three months. In men BMD reaches its lowest values between six months (femur) and one year (acetabulum) after operation and then increases to 96.2% at the femur and 93.8% at the acetabulum. In women BMD decreases during the entire follow-up to 89.4% at the periprosthetic femur and 80.0% at the periprosthetic acetabulum. In the proximal zones 1 and 7 of the femur and the cranial-medial zone II of the acetabulum we observed the highest decrease of mineralisation. More than five years after implantation of the prosthesis BMD in the femur showed only little changes. On the other side BMD around the threaded acetabular cup significantly decreased to 67.4% in women and 79.1% in men. CONCLUSION: The results reflect the different stress on the periprosthetic bone after implantation of the prosthesis and fit to earlier reported good clinical results of the CLS-stem and to increased loosening rate of threaded acetabular cups after five years. Analysing changes of mineralisation in cementless total hip arthroplasty DEXA together with the analization scheme according to Gruen at the femur and to De Lee and Charnley at the acetabulum is a useful method and has been reliable in clinical practise.

Absorptiometry, Photon↗

PubMedDate not supplied

[Results of resection of the head of the ulna].

A follow up of 57 wrists with resection of caput ulnae shows different value to different groups of patients. The painful arthrosis of distal radioulnar joint gives indication in posttraumatic cases. Release of pain and improvement of range of motion will be achieved; loss of strength is the most impairing problem for younger patients. 13 patients out of 21 with posttraumatic deformities were satisfied with the post-operative outcome; 13 patients showed significant loss of strength, too. In case of rheumatoid arthritis with caput-ulnae-syndrome the resection is without alternative, needs to be combined with the arthrodesis of radiolunar-joint, if necessary. 20 of 34 rheumatics were satisfied with the outcome after resection of caput ulnae; in 6 cases an ulnar drift was evident, which implied simultaneous or later partial arthrodesis of the wrist. For all patients release of pain decided on their satisfaction with surgery.

Adult↗

PubMedDate not supplied

[Histologic, morphometric study of the human synovial membrane].

Human synovial membrane was studied by light- and electronmicroscope and histomorphometrically. Areas of distinct structures are seen. The surface structure fold that is mainly seen in the areaolar and adipose synovial membrane type, seemed to be the prime structure for the synovial turn over. Villi have fenestrated capillaries and they are covered of A- and AB-synoviocytes. Villi are regarded as the synovia production areas. The fibrous type of the synovial membrane is mostly smooth surfaced and seemed to be an ordinary fibrous connective tissue. The B-synoviocyte is discussed as fibrocyte.

Adult↗

PubMedDate not supplied

[Diagnosis of hip prosthesis loosening--sensitivity of clinical parameters].

AIM: In order to establish a strategy for early diagnosis of aseptic loosening of total hip arthroplasty (THA) physical examination, patient's assessment and radiographs were analysed. METHOD: Pain, self assessment, physical examination and mobility were examined according to a standard examination protocol in 428 hips of 297 patients after cementless total hip arthroplasty (THA). These findings were compared with the radiographic finding of the hip. Sensitivity and specifity of objective and subjective parameters were analysed. RESULTS: The clinical outcome of THA's is assessed by pain and physical examination. Nearly all hip scores are based on these parameters. In this study sensitivity and specificity of all parameters analysed were unsatisfactory compared with the radiographic finding. Although we found some correlations between clinical and radiological data, clinical data alone are not sufficient for exclusion of THA loosening, especially for loosening of the acetabular component, as there was no clear distinction between the group of radiographically loosened (43 acetabular cups and 4 stems) and intact endoprostheses. CONCLUSION: We conclude, that physical examination and pain history are not sufficient to exclude loosening of cementless THA's. Radiographic examination is essential for the assessment of THA's, even in painfree patients.

Aged↗

PubMedDate not supplied

[Expression of TNF receptors in rheumatoid arthritis and ankylosing spondylitis].

Tumor necrosis factor is an important mediator of the pathophysiologic events in synovitis. The expression of the p75 and p55-TNF-receptors in rheumatic diseases was investigated. Synovial mononuclear cells (SMNC) of patients with rheumatoid arthritis and spondylarthropathies express p75 TNF receptors in all cases, whereas SMNC of patients with traumatic synovitis do not. In 4/9 patients with rheumatoid arthritis and in 6/11 patients with spondylarthropathies SMNC also expressed the p55 TNF receptor. Differential analysis of lymphocytes and monocytes/macrophages revealed that both predominantly expressed the p75 TNF receptor. The highest concentrations of both soluble TNF receptors which may act as TNF antagonists were found in synovial fluids of rheumatoid arthritis patients.

Arthritis, Psoriatic↗