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Biomedical subjects

V Hoikka

Publications and source records attributed to V Hoikka.

At least 37 records · Page 2Linked to original sources
PubMed1990

Cementless total replacement for severely dysplastic or dislocated hips.

We report the short-term results of 100 cementless total hip replacements in 52 severely dysplastic and 48 totally dislocated hips, with some new technical solutions to the problems involved. In cases with a very narrow iliac bone, the acetabular screw ring is seated below the true cotyloid area. In hips with tight flexor and abductor muscles or with deformities of the proximal femur, various osteotomies were performed. Special attention was paid to careful pre-operative planning and precise operative technique. In spite of a high complication rate the results were generally good and even patients who required reoperation were satisfied with the final result.

Adult↗
PubMed1990

Cementless revision of aggressive granulomatous lesions in hip replacements.

In 16 patients we used uncemented Lord prostheses at revision operations for aggressive granulomatosis after cemented hip arthroplasties; in 12 bone grafts also were used. In 13 hips the granulomatous lesions were multifocal, and in one the acetabular component was involved. There was no evidence of infection in any case: all the patients had normal ESR and CRP levels. The revision operation was performed on average 9.4 years after the primary replacement; the mean age at revision was 64 years. On radiographs, the bone around the prosthesis had consolidated by an average of 16 months. At follow-up, two to six years later (mean 3.5 years) there had been no recurrences, nine patients had an excellent Mayo hip score, five were good and two fair.

Adult↗
PubMed1990

Aggressive granulomatous lesions in cementless total hip arthroplasty.

We describe six patients with aggressive granulomatous lesions around cementless total hip prostheses. Two patients previously had a cemented prosthesis in the same hip. The Lord prosthesis was used in five patients, the PCA in one. Both prostheses were made of chrome-cobalt alloy. Pain on weight-bearing occurred on average 3.2 years after the cementless arthroplasty, and at that time radiography revealed aggressive granulomatosis around the proximal femoral stem and the acetabular component in five of the patients; one had a large solitary granuloma in the proximal femur. Revision was performed on average 4.8 years after the cementless arthroplasty. At that time all granulomas had grown large in size; while waiting for revision operation, two femoral stem components fractured. All the granulomas showed a uniform histopathology, which included histiocytosis; the cause for these lesions was thought to be plastic debris from the acetabular socket.

Acetabulum↗
PubMed1989

Leg-length inequality has poor correlation with lumbar scoliosis. A radiological study of 100 patients with chronic low-back pain.

Leg-length inequality and its hypothetical consequences, pelvic tilt and lumbar scoliosis, were measured in 100 young or middle-aged adults suffering from chronic low-back pain. Leg-length inequality had a good correlation with the pelvic tilt assessed from the iliac crests, a moderate correlation with the sacral tilt, but a poor correlation with the lumbar scoliosis. The sacral tilt correlated well with the lumbar scoliosis when the tilt was more than 3 degrees but poorly when it was smaller. Thus, there is a gradually decreasing correlation between the posture parameters when moving from the hips up to the lumbar spine. We conclude that before a radiologically observed leg-length inequality be considered as the cause of low-back pain, an erect-posture radiograph of the whole pelvis and lumbar spine is essential, in order to assess an existing pelvic tilt and scoliosis.

Adult↗
PubMed1989

Results and complications after arthroplasty with a totally constrained total knee prosthesis (GUEPAR).

A series of 51 patients (55 knees) with implanted GUEPAR totally constrained endoprosthesis was followed up clinically and radiologically for a mean of 5.0 years (range 1.5-11.8 years). Good relief of pain, increased range of knee movement and of walking capability were observed. There was, however, an unacceptable amount of severe complications. Three endoprostheses had to be removed and arthrodesis performed. Revision arthroplasty was carried out in 8 cases due to aseptic loosening of the prosthesis. In 25 cases lateral displacement or total dislocation of the patella was confirmed with tangential patellar X-ray projections. We suggest that the GUEPAR totally constrained total knee endoprosthesis and similar constructions should be chosen in only special cases, when aged patients have extremely damaged and unstable knee joints and non-constrained prostheses are not considered suitable.

Adult↗
PubMed1988

Osteoporosis-pseudoglioma syndrome: clinical, morphological, and biochemical studies.

We report a sibship of a sister and brother with osteoporosis-pseudoglioma syndrome. Several other family members became blind or showed signs of bone involvement. There was considerable consanguinity in the pedigree. The proband was small in size and had prominent skeletal deformities and clinical muscle weakness. These features were not present in her brother, suggesting clinical variability. Mental function was normal in both. Bone histology showed osteopenia. Several biochemical events of procollagen biosynthesis were analysed in fibroblast cultures, but no significant abnormalities compared to control fibroblast cultures were detected.

Blindness↗
PubMed1988

Cementless total replacement for old tuberculosis of the hip.

We report the results of cementless total joint replacement in 18 patients with old tuberculosis of the hip, performed, on average, 34 years after the onset of infection. Mean follow-up was 3.5 years. Only seven of the patients had antituberculous drugs during or after the operation. Using the Mayo hip score, 15 patients had excellent or good results and two had a fair rating. One patient had the prosthesis removed more than one year postoperatively for late haematogenous staphylococcal infection and had a poor rating. All the patients had relief of hip-related pain. Despite the absence of any reactivation of tuberculosis in our series, we recommend the use of specific prophylaxis.

Adult↗
PubMed1987

Measurement and restoration of equality in length of the lower limbs in total hip replacement.

Alteration of the length of the lower limb was measured in 39 patients undergoing total hip replacement. Radiographs were taken in the erect posture prior to operation and 6 months postoperatively. The inequality of limb length was measured by the difference between the height of the vertices of the femoral heads and by the difference between the lowest points of the ischial tuberosities. The change of the length was measured intraoperatively as the difference observed between two reference points: one above the acetabulum and the other on the proximal femur. Good correlation was obtained between the change of the limb length made intraoperatively and the change in the limb length using the ischial tuberosities as reference points; no correlation was observed when the vertices of the femoral heads were the reference points. Inequality of limb length can be radiologically determined before and after total hip arthroplasty. Femoral and prosthetic heads are not good reference points for measurement. The difference in the height of the ischial tuberosities demonstrates inequality of limb functional length as it reflects the tilting of the pelvis.

Adult↗
PubMed1987

Bone density, histomorphometry and biochemistry in patients with fractures of the hip or spine.

Bone density in the lumbar spine and distal radius, histomorphometric values of iliac crest biopsies and biochemical parameters, including vitamin D metabolites, were determined in 30 women with recent hip fractures and in 19 women with spinal fragility fractures. In both groups, as compared with age- and sex-matched controls, bone density in the spine and peripheral skeleton was reduced. In the peripheral skeleton the degree of osteopenia in the two groups was equal, but loss of trabecular bone in the spine was disproportionate and more extensive in the group with spinal fragility fractures. In the patients with hip fractures the percentage of trabecular bone occupied by osteoid in the iliac crest biopsies was increased in 11 of the 25 patients. Osteomalacia was further suggested by the lower mean levels of serum calcium and phosphate and lower mean urinary excretion of calcium in this group. In the patients with spinal fractures histomorphometry showed that the osteoid and trabecular resorption surfaces were increased and the relative thickness of the osteoid seams was decreased, indicating increased bone turnover. This evidence was further reinforced by the increased mean serum concentration of 1,25(OH)2D and increased urinary excretion of calcium. The results support the view that these two groups of patients suffer from different forms of osteoporosis.

Adult↗
PubMed1985

Bone density in women with spinal and hip fractures.

Bone density in the lumbar spine and distal radius of 98 postmenopausal women was measured by quantitative computed tomography and in the distal radius by gamma ray attenuation. Nineteen had spinal fragility fractures, 30 had recent hip fractures while 49 were healthy control subjects. The trabecular bone density in spines of the control subjects showed a linear correlation with age corresponding to an annual decrease of 1 per cent and total decrease of 44 per cent between 46 and 86 years of age. Both patient groups had bone density reduction at the spine and peripheral measuring sites as compared with controls. In the distal radius, the reduction in bone density was of the same magnitude in both patients groups but in the spine, the reduction in patients with spinal fracture was more extensive than that in patients with hip fracture. Trabecular bone density in the distal radius and spine correlated in control and hip fracture patients, but not in spinal fracture patients. The results support the opinion that two forms of osteoporosis exist. One is characterised by excessive trabecular bone loss in the axial skeleton leading to spinal fractures; the second is due to equal extents of axial and peripheral osteopenia, found in connection with hip fractures.

Adult↗
PubMed1984

Carbamazepine and bone mineral metabolism.

The status of bone mineral metabolism was studied in 21 epileptic out-patients receiving carbamazepine as the sole anticonvulsant drug. Hypocalcaemia was found in 3, hypophosphataemia in one and elevated serum alkaline phosphatase in 4 of the cases. Serum 25-hydroxyvitamin D values were significantly lower in the patients than in the controls. No statistically significant difference was observed in bone mineral density between the patients and controls. Histomorphometric analysis of the iliac crest cancellous bone did not reveal any statistically significant difference in the amount of trabecular bone or osteoid between the patients and controls, but the patients had an increased amount of trabecular resorption surfaces. An increased amount of osteoid, suggesting histological osteomalacia, was found in 2 of the 18 biopsies. We conclude that epileptic out-patients receiving carbamazepine therapy have vitamin D deficiency and may develop osteomalacic changes in their skeleton.

Adolescent↗
PubMed1982

The nonlinear tissue-binding character of fluoride kinetics in normal and anephric subjects. Graphical analysis of serum fluoride data from man and rabbit.

A study has been made of the fluoride kinetics in man, with a series of 5 healthy subjects and 4 patients with renal insufficiency. The fluoride metabolism was found to conform to nonlinear tissue-binding kinetics. Reanalysis of findings on the rabbit reported in the literature yielded equivalent results. The tissue-binding constants elicited - probably associated with the fluoride metabolism of bone - presented no differences between healthy subjects and uremics. Uremics had a clearly lower fractional fluoride elimination rate (K) compared with the healthy controls. A significant correlation of creatinine clearance on the K value was noted.

Adult↗
PubMed1982

The effect of partial gastrectomy on bone mineral metabolism.

The occurrence of postgastrectomy bone disease was studied in 42 patients who had been subjected to gastric surgery for duodenal or gastric ulceration 5-7 years earlier. Hypocalcemia, hypophosphatemia, and an increase in serum alkaline phosphatase were infrequent. No difference was observed in S-25OHD between the patients and controls, but S-24,25(OH)2D was higher in the patients. The bone mineral density (BMD) values showed no statistically significant difference between the patients and controls before or after the operation. There was a slight fall in BMD values during the follow-up period, but the decrease was similar in the patients and controls and was not statistically significant. The histomorphometric analysis revealed a greater amount of trabecular bone and osteoid in the patients. The means of the osteoid variables were well within normal limits, but a very slight increase in osteoid volume was observed in 4 of the 35 patients. It is concluded that a partial gastrectomy and vagotomy had not caused significant disturbances in bone mineral metabolism. The vitamin D status of the patients was good owing to the adequate dietary regimens that had been given to the patients.

Adult↗
PubMed1982

Osteomalacia in fractures of the proximal femur.

The occurrence of osteomalacia was studied in 58 hip fracture patients who were admitted to the University Central Hospital of Kuopio for operative treatment. Findings indicating osteomalacia were frequent in the series. Hypocalcaemia was found in 70 per cent and an increase in serum alkaline phosphatase in 22 per cent of the patients. Urinary calcium excretion was decreased in 45 per cent and urinary hydroxyproline excretion was increased in 70 per cent of the cases. The serum levels of 25-hydroxyvitamin D and 24,25-dihydroxyvitamin D were significantly decreased in the patients compared with the controls. Histomorphometric analysis revealed no difference in the amount of trabecular bone in the patients compared with the controls, but the amount of osteoid and resorption surfaces was increased in the patients. Histological osteomalacia was found in 12 out of 50 patients (24 per cent). In 10 of these 12 cases the diagnosis of osteomalacia was supported by biochemical changes. There was only one patient, a 29-year-old man with glutein enteropathy who had an evident reason for osteomalacia. The most obvious cause of osteomalacia was the lack of vitamin D due to a deficient diet and lack of exposure to sunlight. The conclusion drawn was that osteoporosis was the main cause and osteomalacia was an important aggravating factor in the bone fragility in these hip fracture patients.

Aged↗
PubMed1982

Treatment of osteomalacia in institutionalized epileptic patients on long-term anticonvulsant therapy.

The efficacy of vitamin D2 in the dose of 2000 IU daily in reversing anticonvulsant osteomalacia was studied in nine epileptic inpatients. The treatment with vitamin D2 was associated with increased serum 25-hydroxycalciferol and 24,25-dihydroxyvitamin D concentrations and partial healing of osteomalacic changes in the cancellous bone of the iliac crest. But it was concluded that the dose of vitamin D2, 2000 IU daily, was too small and that calcium supplementation may be needed in addition to vitamin D therapy.

24,25-Dihydroxyvitamin D 3↗
PubMed1982

Anticonvulsant osteomalacia in epileptic outpatients.

The occurrence of anticonvulsant osteomalacia was studied in 23 epileptic outpatients, and in age and sex matched controls. Hypocalcaemia was observed in 10, hypophosphataemia in 1, and increased serum alkaline phosphatase in 8 of the patients. The serum 25-hydroxyvitamin D concentration was significantly lower In the patients than in the controls, but no difference was found in the serum 24,25-dihydroxyvitamin D concentration between the patients and the controls. There was no difference in bone mineral density between the patients and the healthy controls. In the histomorphometric study, no differences were found in the amount of trabecular bone or osteoid between the patients and the controls, but the patients had a slightly more extensive trabecular resorption surfaces. Histological osteomalacia was found in two of the 23 cases (9%). We conclude that epileptic outpatients on long-term anticonvulsant therapy have vitamin D deficiency and may develop osteomalacia.

Adult↗