PubMed Health⌕ Search

Biomedical subjects

Reinhold Ganz

Publications and source records attributed to Reinhold Ganz.

At least 37 records · Page 2Linked to original sources
PubMed2004

Increased intraarticular pressure reduces blood flow to the femoral head.

Hemarthrosis leading to increased intracapsular pressure after an undisplaced femoral neck fracture is suspected to impair blood flow to the femoral head and may lead to osteonecrosis. We hypothesized that an increase of intraarticular pressure would reversibly decrease the blood flow to the femoral head. Eleven patients having surgical dislocations for treatment of femoroacetabular impingement were included in this study. Saline was injected into the intact intracapsular space while the blood flow to the femoral head was recorded using laser Doppler flowmetry. Injection of saline resulted in an increase in the intracapsular pressure. The injected volume of normal saline until disappearance of the pulsatile signal was on average 20 mL (range, 10-35 mL) with an average intraarticular pressure of 58 mm Hg (range, 25-88 mm Hg). Aspiration of the joint resulted in a return of the pulsatile flow. Hemarthrosis after undisplaced intracapsular fractures of the femoral neck are likely to cause an increase in intracapsular pressure. Decompression of the hematoma to reduce the intracapsular pressure is strongly advocated to optimize blood flow to the femoral head in acute fractures.

Femur Head↗
PubMed2004

Histopathologic features of the acetabular labrum in femoroacetabular impingement.

This paper summarizes clinical and histopathologic findings derived from 25 patients who had surgery for symptomatic femoroacetabular impingement. We explored if observed pathologic features were consistent with hypothesized mechanisms of injury, if severity of osteoarthritis and labral degeneration were associated, and if labral refixation would present an alternative. Clinically, all patients presented with limited range of motion at the hip attributable to pain and a positive impingement test. Magnetic resonance arthrography and surgical observations showed degenerated or ruptured labra or both in the anterior and/or superior regions of the acetabular rim (24 of 25 specimens) which correlated with pain provocation, limited range of motion, and anatomic deformities. Histologically, labra were mostly hyperplastic with disorganized cystic matrices. No inflammation was observed. Spatial distribution of degenerated labral matrices was not different for the two femoroacetabular impingement mechanisms. Labral degeneration and severity of osteoarthritis observed on radiographs did not correlate. In patients having only joint debridement, the labral matrix at the tip, near its vascular supply, was normal. Femoroacetabular impingement is a gentle chronic irritation of the labra located at the site of rupture that elicits a degenerative reaction. In early stages of the disease, the labral tip is not involved, providing the possibility of labral refixation after resection of the degenerated portion.

Acetabulum↗
PubMed2004

Anterior femoroacetabular impingement: part I. Techniques of joint preserving surgery.

The exact pathomechanism responsible for osteoarthritis (OA) of the nondysplastic hip has remained unknown for many years. There is, however, emerging clinical evidence implicating femoroacetabular impingement as an etiologic factor for having early OA of the hip develop. Femoroacetabular impingement is an abutment conflict occurring between the proximal femur and the acetabular rim arising from morphologic abnormalities affecting the acetabulum or the proximal femur, or both. The repetitive mechanical conflict occurring during motion, particularly flexion and internal rotation, can lead to lesions of acetabular labrum and, even more serious, the adjacent acetabular cartilage. Surgical treatment of femoroacetabular impingement focuses on improving the clearance for hip motion and alleviation of femoral abutment against the acetabular rim. We will describe the rationale for the treatment of this condition, and discuss the technique of joint-preserving surgery.

Acetabulum↗
PubMed2004

Anterior femoroacetabular impingement: part II. Midterm results of surgical treatment.

Femoroacetabular impingement has been shown to cause labral and chondral lesions and leads to osteoarthrosis of the hip. With the elimination of the pathogenic cause we hope to prevent or delay additional degeneration of the hip. Fourteen men and five women with a mean age of 36 years (range, 21-52 years) were treated with a surgical dislocation and offset creation of the hip. The followup averaged 4.7 years (range, 4-5.2 years). Using the Merle d'Aubigné hip score, 13 hips were rated excellent to good, with the pain score improving from 2.9 points to 5.1 points at the latest followup. There was no avascular necrosis of the femoral head. Five of the 19 patients, two with Grade 2 osteoarthrosis, two with Grade 1 osteoarthrosis but severe acetabular cartilage damage, and one with untreated ossified labrum had subsequent total hip arthroplasty (THA). In the stable hips without subluxation of the head into the acetabular cartilage defect, no additional joint space narrowing occurred. Surgical dislocation with correction of femoroacetabular impingement yields good results in patients with early degenerative changes not exceeding Grade 1 osteoarthrosis. This procedure is not suitable for patients with advanced degenerative changes and extensive articular cartilage damage.

Acetabulum↗
PubMed2003

Traumatic labral avulsion from the stable rim: a constant pathology in displaced transverse acetabular fractures.

INTRODUCTION: During the treatment of a malunited transverse acetabular fracture, a hitherto undescribed extended avulsion of the labrum from the stable acetabular fragment was found. Based on the labral pathomorphology present in this case, the hypothesis was put forward that traumatic acetabular labral avulsions are a constant phenomenon in transverse acetabular fractures. PATIENTS AND METHODS: Fourteen patients underwent capsulotomy and/or surgical dislocation of the involved hip to facilitate open reduction and internal fixation of transverse acetabular fractures. RESULTS: In all cases, the labrum was partially or completely detached from the superior acetabular rim. In eight cases with bucket-handle tears of the labrum from the stable superior fragment, the injured portion was resected back to normal margins. In one case the labrum was avulsed with an attached piece of bone and was repaired by screw fixation. Small separations of the labrum from the underlying acetabular rim occurred at the level of the fractures in five cases with minor displacement and received no treatment. CONCLUSION: With displaced transverse acetabular fractures, consideration should be given to opening the joint at the time of open reduction and internal fixation to look for associated intracapsular injuries. An avulsed portion of the labrum should be left if stable and undamaged. If unstable and damaged, it is probably better resected and if unstable but intact and/or attached to a bony fragment, it should be repaired.

Acetabulum↗
PubMed2003

Acetabular blood flow during Bernese periacetabular osteotomy: an intraoperative study using laser Doppler flowmetry.

BACKGROUND: The blood flow to the acetabular fragment is of some concern in juxtaarticular pelvic osteotomies used for the treatment of hip dysplasia. No direct measurements have determined the effect of the Bernese periacetabular osteotomy (PAO) on acetabular perfusion. METHODS: Acetabular perfusion was measured by means of laser Doppler flowmetry in 10 patients undergoing a PAO for symptomatic acetabular dysplasia. During the surgical procedure, the intraosseous high energy laser Doppler reliably depicts dynamic changes of small vessel blood flow. Measurements were performed after defined surgical steps to obtain sequential information on the blood perfusion of the acetabular fragment. RESULTS: After complete separation of the acetabular fragment, nine out of 10 patients had pulsatile signals, but the blood flow (BF) significantly decreased by 77%. Corrective positioning of the fragment induced no further drop of the BF signal but a loss of pulsatility in six patients. After a recovery period of about 30 min following preliminary fixation of the fragment, reestablishment of the pulsatile signal and an increase of the BF signal was seen. At termination of the surgical procedure, five out of eight patients, who could be followed throughout the whole procedure, showed a clear pulsatile signal in the supraacetabular area. Bleeding of the supraacetabular cancellous surface could be observed in all acetabula. CONCLUSION: Despite careful preservation of soft tissues during the surgical procedure, a significant reduction of the blood flow in the supraacetabular region has been observed. Nevertheless, a pulsatile signal in more than 60% of the fragments after fragment correction and an increasing signal during the recovery period showed ongoing blood perfusion indicating reversible changes in the measured supraacetabular area. All osteotomies healed within eight weeks without showing signs of necrosis during a minimum follow up of 1 year.

Acetabulum↗
PubMed2003

Femoral osteotomy and iliac graft vascularization for femoral head osteonecrosis.

The objective of this study was to determine the long-term clinical and radiologic outcomes of patients with osteonecrosis treated by a combination of intertrochanteric osteotomy and pedicled iliac bone block transfer. Between 1978 and 1986, 41 patients (52 hips) with a mean age of 33 years were operated on for Ficat Stages II and III disease. Thirty-three patients (44 hips) were assessed clinically and radiologically at a mean followup of 13.5 years (range, 5-20 years). Fifteen hips (15 of 44; 34%; 13 patients) had conversion surgery to a total hip arthroplasty because of progressive arthritis or collapse, or both. Six patients died and two were lost to followup. Preoperatively, the patients with failed revascularization had significantly more pain and decreased gait function than patients without failure. In the patients without failure, postoperative pain sensation and gait function improved significantly. However, flexion became restricted mainly because of progressive degeneration of the hip. Radiographically, 31% of the hips (nine hips; six patients) had severe arthritis, 59% (17 hips; 12 patients) had moderate arthritis, and only three hips (two patients) had mild arthritis. Ninety percent of patients without hip failures (26 of 29 hips; 18 patients) considered the functional outcome, including pain relief and gait function, to be successful. Despite the subjective success, this surgery could not restore normal hip anatomy, and arthritis progressed with time. Intertrochanteric osteotomy and vascularized iliac bone block transfer should be considered only in young symptomatic patients with good preoperative clinical function and Ficat Stage II disease.

Adolescent↗
PubMed2003

Acetabular rim degeneration: a constant finding in the aged hip.

During recent years the acetabular labrum has gained increased interest because its degeneration frequently is found in association with early osteoarthritis of the hip. To determine spatial distribution of labral degeneration in the aged hip and to identify the pathologic features triggering this event, an anatomic postmortem and an intraoperative in vivo study were done in 30 cadavers (range, 60-90 years) and in 18 elderly patients (range, 69-97 years) who had hemiarthroplasty for displaced femoral neck fractures. In both groups, no gross anatomic or radiographic abnormalities suggesting advanced osteoarthritis were present. All cadaveric acetabuli (30 of 30) revealed labrum and cartilage damage. Labrum damage (17 of 18) and cartilage lesions (16 of 18) occurred less frequently and were smaller in the elderly patients. Peripheral joint degeneration was most frequent at the superior acetabular rim close to the anterior inferior iliac spine. More centrally localized cartilage lesions were present in 47% of cadavers and in 28% of patients. The majority of femurs (cadavers) (80%) showed reduced narrowing at the anteromedial femoral head-neck junction causing impingement against the corresponding acetabular rim or squeezing of this area into the joint during flexion, whereas the femoral head cartilage appeared normal in all but one hip. Acetabular rim degeneration is a constant finding in the aged hip, which seems to be triggered by femoroacetabular impingement.

Acetabulum↗
PubMed2003

Women awaiting knee replacement have reduced function and growth hormone.

Women experience greater functional impairment and occurrence of osteoarthritis than men. We hypothesized that lower levels of serum insulin-like growth factor-I may contribute to gender differences in physical impairments. A cross-sectional comparison (n = 139) was done on candidates having total knee arthroplasty and healthy controls subjects of similar age (range, 55-75 years). Physical function, perceived function, and serum insulin-like growth factor levels were compared across group and gender using analysis of variance. Insulin-like growth factor-I values were markedly reduced in women overall and women having surgery had significantly reduced levels despite lean body mass correction. Values consistent with clinical hormone deficiency were observed in 21% of women and only 4% of men having arthroplasty. Physical function was markedly reduced in women, at times functioning only 33% when compared with healthy women, whereas men's limitations were not as profound. The current findings indicate that physical function is more impaired and serum insulin-like growth factor-I is markedly reduced in women awaiting arthroplasty than their male counterparts. The gender differences observed biochemically and with functional performance indicate that the pathophysiology of end stage osteoarthritis may differ between men and women.

Activities of Daily Living↗
PubMed2003

Femoroacetabular impingement: a cause for osteoarthritis of the hip.

A multitude of factors including biochemical, genetic, and acquired abnormalities may contribute to osteoarthritis of the hip. Although the pathomechanism of degenerative process affecting the dysplastic hip is well understood, the exact pathogenesis for idiopathic osteoarthritis has not been established. Based on clinical experience, with more than 600 surgical dislocations of the hip, allowing in situ inspection of the damage pattern and the dynamic proof of its origin, we propose femoroacetabular impingement as a mechanism for the development of early osteoarthritis for most nondysplastic hips. The concept focuses more on motion than on axial loading of the hip. Distinct clinical, radiographic, and intraoperative parameters can be used to confirm the diagnosis of this entity with timely delivery of treatment. Surgical treatment of femoroacetabular impingement focuses on improving the clearance for hip motion and alleviation of femoral abutment against the acetabular rim. It is proposed that early surgical intervention for treatment of femoroacetabular impingement, besides providing relief of symptoms, may decelerate the progression of the degenerative process for this group of young patients.

Acetabulum↗
PubMed2003

Malunion following trimalleolar fracture with posterolateral subluxation of the talus--reconstruction including the posterior malleolus.

Malunion after a malleolar fracture can include a displaced posterior malleolus with associated posterolateral subluxation of the talus. Corrective osteotomy including the posterior malleolus was performed in four patients. Joint congruity was obtained in every case. The patients were followed for 46 to 80 months postoperatively. They all experienced an improvement in pain and three of four patients were unlimited in their walking capacity. Mild to moderate residual symptoms were frequent. The symptoms were attributed to the damage of the cartilage and soft-tissues both from the initial injury and from weightbearing on the incongruous joint. Discrete, non-progressive osteophytes were seen in all patients. Delay in reconstruction did not preclude a good result, although early reoperation is felt to be preferable.

Adult↗
PubMed2002

Association of plasminogen activator inhibitor-1 genotype with avascular osteonecrosis in steroid-treated renal allograft recipients.

BACKGROUND: The mechanism of avascular osteonecrosis (AVN) is controversial. Besides an increased bone marrow pressure with reduced blood supply, an enhanced coagulation has been considered. We hypothesize that a genetic variant of the plasminogen activator inhibitor-1 (PAI-1) determines the risk of AVN in glucocorticoid-treated patients. METHODS: Genotyping for the 4G/5G PAI-1 polymorphism was performed in 228 glucocorticoid-treated renal transplant patients. AVN of the hip was present in 26 patients. Magnetic resonance imaging (MRI) of the hips was obtained in 81 of the remaining renal transplant patients without clinical symptoms of AVN. RESULTS: The presence of the homozygous 4G/4G PAI-1 genotype was higher in patients with AVN (60.3%) as compared with patients without either clinical (20.6%, P<0.007) or radiological signs of AVN (17.3%, P<0.002). The prevalence of AVN by genotype was 1.8% with the 5G/5G, 7.7% with the 5G/4G, and 30.3% with the 4G/4G alleles (P<0.001 vs. 5G/4G and 5G/5G). The prevalence of AVN increased with increasing body mass index (BMI) (P=0.04). The prevalence of AVN by genotype in subjects with persistent hyperparathyroidism was 4.2% with the 5G/5G, 15.2% with the 5G/4G, and 55.5% with the 4G/4G alleles (P<0.003 vs. 5G/4G and P<0.001 vs. 5G/5G). CONCLUSIONS: Hypofibrinolysis conferred by the 4G/4G PAI-1 gene variant is a major predisposing factor for AVN in renal transplant patients. The risk is particularly high in obese subjects or patients with persistent hyperparathyroidism. A prospective intervention study of early anticoagulation after renal transplantation is needed to assess whether glucocorticoid-associated AVN can be prevented.

Adult↗
PubMed2002

Osteochondroma of the femoral neck.

Osteochondromas of the femoral neck represent intraarticular lesions and are difficult to access for surgical resection, especially when located posteriorly. A versatile surgical approach with dislocation of the femoral head is described through which reliable resection of the osteochondroma can be done respecting the crucial blood supply to the femoral head, the deep branch of the medial femoral circumflex artery. Surgical femoral head dislocation offers the possibility of excellent visualization, circumferential access to the femoral neck, and complete intraarticular inspection. This approach has been used in four patients with osteochondroma of the femoral neck who presented with pain, restricted range of motion, and a limp. Femoroacetabular impingement of the bulky osteochondroma against the acetabular rim could be verified in all patients. In two patients labral lesions were found at the impingement site. All patients had prompt bleeding intraoperatively from a 2.0-mm drill hole of the femoral head after resection of the osteochondroma. There were no or minimal symptoms after a median followup of 34 months (range, 18-48 months) and no clinical or radiographic signs of avascular necrosis of the head.

Adult↗
PubMed2002

Surgical dislocation of the femoral head for joint debridement and accurate reduction of fractures of the acetabulum.

OBJECTIVES: To evaluate fracture reduction, femoral head viability, and outcome of selected acetabular fractures treated operatively using a modified Kocher-Langenbeck approach with a trochanteric flip osteotomy and surgical dislocation of the femoral head. DESIGN: Prospective. PATIENTS: Twelve patients predominantly with combined transverse and posterior wall fractures or multifragmentary posterior wall fractures. OUTCOME EVALUATION: Clinical and radiographic analysis after a minimum 2-year follow-up. METHODS: A single modified approach, including anterior ( = 8) or posterior ( = 4) surgical dislocation of the femoral head, was done in 12 patients for one or more of following reasons: intra-articular assessment of reduction in fractures with comminution, marginal impaction and involvement of the anterior column, removal of intra-articular fragments, and confirmation of extra-articular screw placement. RESULTS: At a mean follow-up of 35 months (24-48 months), the 12 patients presented with a good to excellent clinical result according to the D'Aubigné score. One patient developed postoperative osteoarthritic changes after an imperfect reduction. No heterotopic ossification interfering with hip function was found. None of the hip joints developed signs of avascular necrosis of the femoral head, even though seven patients sustained a posterior dislocation at time of the injury. CONCLUSION: This study indicates that this technique for surgical dislocation of the femoral head is safe and facilitates assessment of fracture reduction in selected acetabular fractures.

Acetabulum↗
PubMed2002

Modification of the ilioinguinal approach.

The classic ilioinguinal approach has become well established in the treatment of acetabular fractures. However, in certain cases with extensive low anterior column or anterior wall fractures less than optimal exposure may be obtained. The authors present a modification of the ilioinguinal approach by combining it with a Smith-Petersen approach with a modified skin incision. This provides improved visualization and access, especially in comminuted low anterior column and anterior wall fractures, may facilitate reduction maneuvers to the quadrilateral surface, and allows the option of intraarticular inspection. In addition, the risk of iatrogenic lateral femoral cutaneous nerve damage is diminished. In this article the technique of this modification is described and illustrated.

Acetabulum↗