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Biomedical subjects

N Böhler

Publications and source records attributed to N Böhler.

At least 19 recordsLinked to original sources
PubMed2003

[Minimally invasive medial unicompartmental knee replacement].

Medial unicompartmental knee replacements have been used for more than 40 years. Due to increased experience in determining the indication for use and improvements in design of the prosthesis and tribology, the long-term results have now reached a high level. The advantages of these systems are less bone loss and better proprioception. The disadvantage is the risk of panarthrosis, which might be reduced by accurate indications for operations. Good indications are patients older than 60 years with normal weight and normal sports activity. Well-functioning collateral and cruciate ligaments are mandatory. Due to the fact that during implantation eversion of the patella is not necessary, a minimally invasive approach might be used. Overcorrection of the mechanical axis of the leg should be avoided. By observing these principles, very good long-term results can be achieved with medial unicompartmental arthroplasty. Better proprioception and better mobility of the knee are advantages of these implants compared to total knee arthroplasty. In the case of revision with a bicondylar implant, the situation is less complex compared to revisions after osteotomies or bicondylar replacements. Remobilization in this situation is shorter with better results compared to a revision with a bicondylar prosthesis.

Age Factors↗
PubMed2003

Cementless total hip arthroplasty in patients older than 80 years of age.

We reviewed 80 patients (87 hips) who were older than 80 years of age at the time of cementless total hip arthroplasty. An Alloclassic SL stem had been implanted in all patients. A variety of cementless acetabular components was used. After a mean follow-up of 69.3 months (39.2 to 94.1) 48 hips in 43 patients were analysed clinically and radiologically. One patient had sustained a traumatic periprosthetic fracture of the femur with subsequent exchange of the stem 73 months after operation. Thirty-two patients (34 hips) had died and five patients (five hips) were unavailable for follow-up because of health reasons (four patients) or lack of co-operation (one patient). If the endpoint is defined as removal of the prosthesis because of aseptic loosening, the survival rate was 100% for the cup and stem after 78 months. The mean Harris hip score was 81.9 points. Radiolucent lines and osteolysis were seldom found.

Aged↗
PubMed1995

Metal/metal articulating interfaces.

Polyethylene wear can be shown as a problem in long-term joint replacement. Metal-on-metal bearing is solving this problem, as long-term clinical and experimental investigations demonstrate. To avoid the problem of high friction found in old series, a new Metasul called technique with a smaller diameter was invented. Intermediate results of Weber and our own data show promising outlook for a solution to the wear-induced problem in hip replacement.

Hip Prosthesis↗
PubMed1990

[Indications for immunoscintigraphy in orthopedics and its interpretation].

In the view of an orthopedist the immunscintigraphy is a diagnostic and differential diagnostic enrichment. The MAK BW 250/183 is stored in a lyophiled shape. The MAK is marked with 99m Tc with little expense and in a short time. The advantage of the immunscintigraphy is the high sensitivity for places where granulocytes are gathered. The immunscintigraphy proved to be a very good proceed in recording acute inflammations.

Abscess↗
PubMed1990

[Kinetics and immunocytochemical staining of 99mTc-labeled monoclonal anti-CEA antibodies against granulocytes following intravenous administration].

Until now the clinical identification of the affinity of monoclonal 99mTc-anti-CEA antibodies (MAK BW 250/183) on granulocytes was made with tumor cells carrying the same epitope on NCA-95 and human granulocytes in vitro. As this antibody only binds human granulocytes, animal experiments are impossible. 3 patients had their blood withdrawn within 6 h after injection, another patient had his left hip-joint biopsied after 24 h, the samples undergoing subsequent immunocytochemical dyeing. Dyeing of granulocytes all over the smears was evident whereas lymphocytes, monocytes and erythrocytes did not show any reaction. After 6 h there seemed to be a large difference between a relatively high quantity of 86% unlabelled 99mTc-MAb and 75% of immunocytochemically stainable granulocytes in the blood through an excess of binding epitopes. Six h after injection 27% of the activity were, on average, detectable in whole blood. At this time the activity in blood was reduced to an extent that scintigraphic imaging was feasible.

Adult↗
PubMed1983

[Human calcitonin in the treatment of symptomatic Paget's disease].

We evaluated the effect of a 6 months trial with synthetic human calcitonin in 10 symptomatic patients with polyosseous Paget's disease of bone. All patients reported a distinct clinical improvement which correlated with a significant decrease of alkaline phosphatase in the plasma and hydroxyproline and calcium excretion in the urine. Though no changes in skeletal x-rays were observed, the bone lesions showed a significant decrease of activity in tho bone scintigrams. Histologically there was a marked decrease of bone turn-over calcitonin therapy. No patient revealed the formation of autoantibodies against exogenous calcitonin after treatment.

Aged↗
PubMed1982

Evidence for negative correlation between quantitative histological studies and microradiography of iliac crest bone and forearm osteodensitometry in elderly women with osteoporosis.

Quantitative histomorphometric and microradiographic analysis of iliac crest bone biopsy specimens of 10 unselected and untreated postmenopausal women with osteoporosis was performed and the results were correlated with the values measured by osteodensitometry on the right forearm. No positive correlation between histomorphometry or microradiography and osteodensitometry was observed. Moreover, the data of various histomorphometric parameters and those of the bone mineral content measured by microradiography revealed a significant negative correlation when compared to the values obtained by osteodensitometry. Our results suggest, that evaluation of one skeletal site is not necessarily representative of the entire skeleton in patients with postmenopausal osteoporosis.

Aged↗
PubMed1979

[Extended elbow synovectomy in primary chronic polyarthritis. Long-term results].

In 50--70% of the rheumatoid patients arthritis of the elbow joint can be found. Early results after surgical treatment are very successful. The late results after 29 synovectomies, partly with resection of the head of the radius and neurolysis of the ulnar nerve, are presented. The follow-up time averages 6 years. We found a good relief of pain and a moderate, but persisting gain of movement. The importance of an early operation and a consequent physical therapy is pointed out.

Arthritis, Rheumatoid↗
PubMed1977

[Results of the Ender-nailing method in Austria. With special reference to the cases of the Lorenz-Böhler-Hospital (author's transl)].

The problems of the method are briefly analyzed by the early results of together 2137 patients, who were operated in 10 different traumatological departments or accident-hospitals and by the late results of 109 patients, who were followed up in the Lorenz-Böhler-Hospital. The advantages of the Ender-method are: 1. relatively minimal operative stress to the patients (there are nearly no contraindications); 2. the low infection rate of 1.9%; 3. the favorable mechanical principle of these osteosynthesis, so that in 2137 there was no case with broken nails and no case with nonunion. 4. Rotational stability is better, than by Küntscher's trochanteric nail, because of the diverging tips of the nails in the head of the femur. Furthermore the insertion of the Ender nails does not injure the medial collateral ligament of the knee. 5. External rotation failures of the femur can be avoided by bending the nails in a second plane corresponding to the antetorsion angle of the collum femoris.

Aged↗
PubMed1976

Treatment of intertrochanteric and subtrochanteric fractures of the hip by the Ender method.

Ender's method of intramedullary fixation of intertrochanteric and subtrochanteric fractures is described. Ender's nail is a pre-bent flexible steel nail with a diameter of 4.5 millimeters. Three to five of these nails are inserted from a small incision proximal to the medial epicondyle of the femur into the medullary canal. They are passed through the femur across the fracture site and into the head of the femur, where they diverage. They are in the lines of force and therefore are not subjected to bending moments. The fracture fixation allows immediate weight-bearing. This method of fixation was used in a series of 203 patients. Their average age was sixty-eight years; the mortality rate was 10.3 per cent. In 3.9 per cent superficial infections occurred, but in no case was there a deep infection involving the bone. Functional return (walking) was achieved in all of the survivors who were able to walk at the time of injury, and there were no nonunions.

Adult↗
PubMedDate not supplied

[Radiological appearance of the cementless ALLOCLASSIC SL-stem implanted in very old patients with primary hip osteoarthritis].

AIM: The radiological appearance of the cementless ALLOCLASSIC SL-stem, implanted in patients with primary osteoarthritis of the hip and aged at least 80 years at time of surgery, was investigated. METHOD: 66 hips in 58 patients were analysed. 17 patients (19 hips) died in the interim, 5 patients (5 hips) were not available for follow-up because of health reasons (4) or lack of co-operation (1). 1 stem had to be explanted after a periprosthetic fracture of the femur. Finally, 41 total hip arthroplasties in 35 patients could be analysed after an average of 67.9 months (39.2-93.4). RESULTS: Bone atrophy - especially in the proximal Gruen zones - was frequently found. In contrast, radiolucent lines and osteolyses were rare occurrences. The Harris Hip score was preoperatively on average 33.0 points, at time of follow-up 81.7 points. The survival rate (endpoint aseptic loosening) was 100 % after a mean follow-up of 5.7 years. CONCLUSION: Also in very old patients the implantation of a cementless stem is possible and provides very good results.

Aged↗
PubMedDate not supplied

[Influence of local anesthesia and energy level on the clinical outcome of extracorporeal shock wave-treatment of chronic plantar fasciitis].

BACKGROUND: The efficacy of low energy extracorporeal shock wave treatment (ESWT) for chronic plantar fasciitis is discussed controversially. It is unclear whether the simultaneous application of local anesthesia (LA) interferes with clinical outcome. METHODS: 60 patients with a chronic plantar fasciitis were enrolled in a triple-arm (20 patients per group), prospective randomized and observer-blinded pilot trial. The patients were randomly assigned to receive either active ESWT without LA (;3 x 1 500 shocks, total energy flux density [EFD] per shock 0.09 mJ/mm(2) [Group A]), ESWT with LA (3 x 1 500 shocks, EFD 0.18 mJ/mm(2) per shock [Group B]) or ESWT with LA (3 x 1 500 shocks, EFD 0.09 mJ/mm(2) [Group C]). Main outcome measures were: pain during first stepps in the morning (measured on a 0-10 point visual analogue scale) and number of patients with > 50 % reduction of pain and no further therapy needed, measured at 6 weeks after the last ESWT. RESULTS: Group A improved in the VAS from 6.4 (SD: 1.7) to 2.2 (SD: 2.6) points, group B from 6.7 (SD: 1.5) to 4.1 (SD: 2.4) points, group C from 6.2 (SD: 1.6) to 3.8 (SD: 2.5) points. A reduction of pain of at least 50 % was achieved in 60 % of group A, in 36 % of group B and in 30 % of group C. Group A without LA showed a significantly higher improvement in the VAS and subjective evaluation than groups B (p = 0.007) and C (p = 0.016). CONCLUSION: At 6 weeks success rates after low-energy ESWT with local anesthesia were significantly lower than after identical low-energy ESWT without local anesthesia. Higher energy levels could not balance the disadvantage of this effect. LA significantly influenced the clinical results after low energy ESWT in a negative way. Blinding patients by LA in ESWT studies must therefore be considered a systematic error in study design.

Adult↗