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At least 289 records · Page 16Linked to original sources
PubMed2003

[The hinged knee prosthesis: outdated design or valuable implant for difficult cases?].

There are excellent results after unconstraint or semiconstraint bi- or tricompartimental total knee arthroplasty in case of uncomplicated degenerative joint disease of the knee. In the Swedish knee study, cumulative survival of unconstraint or semiconstraint knee prostheses was about 90 % at 10 years. In studies of single institutions, survival rates of more than 90 % at 15 years are reported. However, there is a need of more constraint designs because of the increasing number of complex total knee arthroplasties with disrupted collateral ligaments, deformities with flexion extension gap imbalance, comminuted distal femur fracture, distal femoral non-union in elderly patients and revision with massive bone loss. Initial hinged total knee designs were associated with a high failure rate. More recent designs have improved the femorotibial articulation and reduced the polyethylene wear. The bone resection necessary in actual hinged designs is similar to the resection in modern condylar prostheses. Due to these improvements, long-term survival of the best hinged designs are similar to the best condylar designs. In our study of a consecutive series of 422 hinged Blauth prostheses, the cumulative survival of the prostheses was 94.4 % at 20 years. Therefore, the hinged knee prosthesis is a valuable implant in case of complex total knee arthroplasty.

Aged↗
PubMed2003

[Rupture of the gluteus medius tendon].

AIM: Rupture of the gluteus medius tendon is a rare, even neglected condition. Typical findings include local tenderness and weakness of hip abduction. This pathologic condition is very seldom analysed in the literature, there is no report about the meaning in primary total hip replacement (THR). PATIENTS: Between 1/1/1995 and 12/31/2000 we found 13 cases (3,5 %) with a tear of the gluteus medius tendon in 372 primary THR using the lateral approach. In all cases the rupture was seen in the ventral and lateral part of the gluteus medius tendon. Furthermore, a valgus position of the proximal femur was detected. Transosseous refixation of the tendons was performed in all cases. 3 months after operation local tenderness near the greater trochanter disappeared and full strength of the pelvitrochanteric muscles was achieved in 11 out of 13 cases and in the remaining cases after one year. CONCLUSION: When a valgus position of the proximal femur in primary THR is found, one has to be aware of a simultaneous rupture of the gluteus medius tendon. This pathologic finding has to be ruled out preoperatively by means of ultrasound or MRI and an adequate approach to the hip joint has to be selected to examine the pelvitrochanteric muscles and to treat the rupture.

Aged↗
PubMed2003

[Computed tomography of the patellofemoral alignment after arthroscopic reconstruction following patella dislocation].

PURPOSE: To evaluate the diagnostic impact of different CT-based measurements to analyze the patellofemoral alignment after arthroscopic reconstruction in patients with patella dislocation. MATERIALS AND METHODS: In 18 patients with dislocation of the patella, CT of the patellofemoral joint was performed after arthroscopic reconstruction. Various methods recommended in the literature were used to analyze the structure and the alignment of the patellofemoral joint with a relaxed quadriceps muscle. Axial CT scans were taken in four different knee flexion angles (15 degrees, 30 degrees, 45 degrees, 60 degrees ). RESULTS: After arthroscopic stabilization in patients with patella dislocation, only the lateral patellofemoral angle (15 degrees and 30 degrees knee flexion) and the congruence angle (15 degrees knee flexion) showed significant differences between the CT-measurements in the normal and the operated group. The differences of the remaining mean values were not significant due to a high standard deviation. With increasing flexion of the knee, the differences between the normal and the dislocation group almost disappeared. Only the lateral patellofemoral angle, the patella tilt and the lateral patella shift revealed differences between the normal and the group with recurrent dislocation in every degree of knee flexion. With increasing knee flexion above 30 degrees and especially at 60 degrees, the majority of the measured values returned to the normal range. CONCLUSIONS: For CT-measurements of the patellofemoral joint after arthroscopic stabilization, the patellofemoral angle and the congruence angle seemed to be most useful. The measurements of the patellofemoral joint should be taken in various degrees of knee flexion.

Adolescent↗
PubMedDate not supplied

[Development of a 3-dimensional method to determine the tibial slope with multislice-CT].

AIM: The measurement or, respectively, the correction of the tibial slope is an important subject in the field of knee arthroplasty and in the procedure of cruciate ligament reconstruction. However, a valid value of the tibial slope cannot be obtained from the conventional plain X-rays in a reproducible way. The aim of this study was to evaluate the proximal tibial slope with a new CT measurement system and to compare the values with the X-ray method. METHOD: Using 6 cadaver tibiae, the antero-posterior slope of the proximal tibia was measured at 0 degrees, 2.5 degrees, 5 degrees, 10 degrees, 15 degrees, 20 degrees, 30 degrees internal rotation using the plain X-ray and spiral CT (3D-MPR reconstruction). Both methods were compared. RESULTS: The variation of the measurement of the tibial slope with the X-ray method was > 5 degrees even if the optimal 0 degrees rotation in the lateral view was applied. Moreover, the measurement error increased to 14 degrees while increasing the rotation of the tibia. Using the new CT system, the error was less than 3 degrees in all measurements. CONCLUSION: The measurement of the tibial slope in the conventional X-ray technique showed a high variation of the values depending on the rotation of the tibia in the lateral view. In contrast, the measurements with the new CT system represented a precise method with a small variation of the tibial slope values. For this reason detailed questions regarding the precise anatomy of the proximal tibia cannot be answered precisely with plain X-rays.

Anterior Cruciate Ligament↗
PubMed2003

[Measurement of the AT and the CCD angle of macerated cadaver femora: a comparative study between CT and MRI measurements].

PURPOSE: To compare measurements of the real AT (femoral antetorsion) and CCD (caput-collum-diaphysis) angle by computed tomography (CT) and magnetic resonance imaging (MRI) of hip specimen using direct measurements as reference standard, and to show that measurement by MRI can replace CT measurements and may help avoiding X-ray exposition. MATERIALS AND METHODS: CT and MRI measurements were obtained on 25 in water-arrested macerated human femora. Postprocessing was done by 4 independent readers on a workstation using a dedicated 3D-software. Direct measurements of the real AT and the CCD angle were used as reference standard. The analysis included Student's t test for paired values, interobserver variability using intra-class correlation coefficients (ICC), maximum and middle divergence of the angles, and Bland-Altman plots. RESULTS: For determining AT and the CCD angle with CT and MRI, good correlation was found between the 4 readers and with measurements using the reference standard. ICCs were 0.97 and 0.90 for measuring AT and CCD angle with CT, and 0.95 and 0.71 for measurements with MRI, respectively. Mean divergence between CT measurements and those of the reference standard was 0.8 degrees for AT and 0.7 degrees for the CCD-angle. Mean divergence between MRI measurements and those of the reference standard was 0.3 degrees for AT and -0.4 degrees for the CCD-angle. Mean divergences between CT and MRI measurements of AT and CCD-angle were 0.5 degrees. Neither systematic errors nor dependences on the qualitative size of the reference data were evident in the divergences of measurements. CONCLUSION: Measurements of the real AT and CCD angle by CT and MR imaging revealed a good correlation with direct measurements of the femoral specimen and consequently can be recommended for clinical use. MRI measurements can replace CT measurements, avoiding X-ray exposure especially in young patients undergoing preoperative evaluation for hip dysplasia.

Bone Malalignment↗
PubMedDate not supplied

[Posteromedial bowing of the lower leg and neuroblastoma with possible neurofibromatosis type I: a case report and literature review].

BACKGROUND: The posteromedial bowing of the tibia is a rare condition that is not yet known to be related to neurofibromatosis. The case of a three month-old boy with the tentative diagnosis of neurofibromatosis is described. He developed paraplegia due to an abdominal neuroblastoma at the age of 9 months. This led us to a review of the literature. METHOD: 122 cases of posteromedial bowing of the tibia in 20 publications of the years 1949 - 2000 were analysed under special respect to gender, side of affection, shortening of the lower leg, treatment and possible cause. RESULTS: The posteromedial bowing of the lower leg seems to affect more boys as well as the left side. As far as described in all but one case it was the first delivery. Regularly, a limb shortening and pes calcaneovalgus is to be found. 99 children were treated conservatively, 21 got an operation of the affected side. In 19 performed osteotomies no pseudarthrosis occurred. One case of a fracture due to an adequate trauma without healing problems is described.

Abdominal Neoplasms↗
PubMedDate not supplied

[Assessment of implant position of CTX-custom-made stems with EBRA-FCA in 107 cases of total joint replacement].

AIM: The aim of this study was to assess the ratio of correct and malpositioned stems in a THR population with custom-made stems. Furthermore, any relation of the extent of deviation from the exact stem position and defined patient variables was evaluated. METHODS: Preoperatively, in three-dimensional virtual reality, CTX-individual hip stems were positioned in femora reconstructed from the individual patient's CT data until a stable cortical fit was achieved. Postoperative femoral stem position was measured with EBRA-FCA (EinzelBildRontgenAnalyse-Femoral Component Analysis). Differences of planned and actual depth of stem position were calculated for 107 CTX-custom-made hip stems implanted at one institution. RESULTS: Compared to preoperative planning 59 hip stems were placed too high, while 16 were placed exactly to within one millimeter and 32 were positioned too low. Deviations of postoperative stem position from preoperative planning did not correlate with previous femoral osteotomy found in one-third of femora or femoral anteversion exceeding 25 degrees as present in two-thirds of patients. CONCLUSION: In 71 % the intraoperative stem position did match the preoperative CTX-implant fitting into virtual patient femora. 29 % of implanted stems were malpositioned, i. e., deviations were greater plus or minus 5 mm to preoperative computer planning. None of the examined variables such as body mass index, previous femoral osteotomy, surgical approach, abnormal anteversion angle served as a predictive value for CTX-stem position in this cohort.

Bone Malalignment↗
PubMedDate not supplied

[Value of alignment osteotomy of the proximal tibia in the endoprosthesis period].

AIM OF THE STUDY: To evaluate the value of high tibial osteotomy in times of growing numbers of endoprostheses we compared our personal with other results of this method as well as of the unilateral sledge prosthesis. MATERIAL AND METHODS: Between 1972 and 1993 the high tibial osteotomy as described by Coventry was performed in 105 patients. 98 patients could be examined clinically-radiologically and evaluated with a questionnaire. The indication for surgery was given in patients with unilateral arthrosis without affection of the retropatellar joint and without significant ligamentous instability. The varus deviation was in no case more than 10 degrees. The average follow-up for the clinical-radiologic examination was 9.4 years. RESULTS: 77 patients (78.6%) were satisfied with the outcome of the surgery. Here it was seen that neither age nor pain or instability had an influence on this judgement. The walking distance on the other hand had a significant influence. Stair climbing and range of motion were significantly important as well. 23 patients gave the judgement "excellent", 31 "good", 36 "satisfactory" and 8 patients were "not satisfied". A significant influence of patient age on the judgement could not be proven. The division in the Japanese Score showed "good" results in 14%, "moderate" in 81% and "poor" in 5%. 13 knee joints (13.3%) were absolutely pain-free and in 67 cases (68.4%) there were a definite pain reduction. A significant correlation between the preoperative axis deviation and pain could not be found. An average flexion of 97.5 degree and an extension deficit of 3.3 degree on average was seen. A significant difference of range of motion dependent on age groups could not be found. In 42 knees (42.9%) the lateral ligaments were clinically stable, in 35 cases (35.7%) there was a first degree lateral stress gap and in 21 cases (21.4%) there was a second degree lateral instability. A significant correlation between the instability and age or pain could not be proven. 13 revision surgeries including 9 endoprosthesis implantations were performed. CLINICAL RELEVANCE: The study showed a high level of satisfaction with an exact surgical indication. When seeing the growing number of implanted uni- or tricompartmental endoprostheses the procedure of tibial osteotomy can be suggested for patients with unilateral arthrosis without retropatellar arthrosis, with an axis deviation less than 15 degrees, with unaffected cartilage of the contralateral compartment and without ligamentous insufficiency independent of patient age.

Adult↗
PubMedDate not supplied

[Change in the CCD angle and the femoral anteversion angle by hip prosthesis implantation].

PURPOSE: The aim of the present study was to measure and interpret the change of the collodiaphyseal (CCD) angle and femoral anteversion after total hip replacement. METHODS: We prospectively examined 52 patients with coxarthrosis, who were treated by total hip replacement. Preoperatively and postoperatively we used a standard X-ray ap view to measure the CCD angle and computerized tomography to determine the femoral anteversion. These projected angles were converted into the real angles by using the method of König and Schult. RESULTS: On average the preoperative real CCD angle was 128 degrees (+/- 8.9 degrees) and the postoperative angle 145 degrees (+/- 4.8 degrees), preoperatively the real femoral anteversion angle was 14.1 degrees (+/- 6.9 degrees) and postoperatively 10.8 degrees (+/- 6.2 degrees). CONCLUSIONS: The effect of the postoperative valgisation can be explained by the given CCD angle of the used femoral stem prosthesis of 140 degrees (cemented Weller II stem) and 145 degrees (cementless CLS classic stem). It is possible that due to the valgisation and the decreased offset of the femoral stem prosthesis compared to the preoperative conditions the gluteal muscles are insufficient and overloaded. It is also known that the change of the femoral anteversion from the physiological conditions causes an increase of the torsional moment. The resulting increased interface load could possibly be a reason for loosening of the femoral stem. The conclusion can be drawn that the CCD angle and the femoral anteversion should more carefully be considered by the surgeon in total hip replacement. This could be reached by an exact implantation technique and the choice of the appropriate stem prosthesis with different CCD angles.

Adult↗
PubMedDate not supplied

[Decreased acetabular anteversion and femur neck antetorsion cause pain and arthrosis. 1: Statistics and clinical sequelae].

PROBLEM: This paper investigates which angles of acetabular (AA) and femoral antversion (FA) have to be considered as normal and which ones cause changes in range of movements, pain and osteoarthrosis. METHOD OF INVESTIGATION: 15-20 degrees of anteversion of AA and FA were tested regarding normality. Diminished anteversion angles were divided in groups -2 and -3, and increased angles in groups +2 and +3. RESULTS: The material consisted of 356 hip joints with computerized tomographies, investigated separately in different deformities. Changes in range of movement, pain and osteoarthrosis were minimal in the normal angle group 1 and increasing in the extreme angle groups -2 and -3 and +2 and +3. Diminished AA and FA cause a decrease of internal rotation of the hip and an increase of external rotation, pain and osteoarthrosis. When groups of diminished AA or FA angles were found combined with the normal angle group 1 or increased angles of AA or FA (+2/+3), the pathological consequences were compensated or diminished especially by higher FA angles and less by AA angles. The results in all investigations were statistically significant if the number of observations was large enough. The instability index of McKibbin was used in the different angle groups of deviation from normal. Adding the angles of AA and FA together gives a good impression of the degree of instability or rigidity and the prognosis of the joint. SIGNIFICANCE: In children and adults diminished AA and FA are quite frequent. They cause pain and osteoarthrosis, but are diagnosed seldom.

Acetabulum↗
PubMedDate not supplied

[Decreased acetabular anteversion and femur neck antetorsion cause pain and arthrosis. 2: Etiology, diagnosis and therapy].

ETIOLOGY: Differences in the anteversion of the acetabulum and the femur must be attributed to the different rotational postures of the fetus as investigations and experiments have shown. After delivery there is a spontaneous improvement, but in perhaps 15% of the joints, diminished or increased acetabular or femoral anteversion will persist during later life. The results of the investigation of Part 1 are compared with the literature. So far no correlations between AA/FA and different clinical consequences have been reported. The deformity of diminished AA and FA is found as a singular entity, also as one of the causes of slipped capital femoral epiphysis. It is frequently combined with coxa vara, also with deep acetabula and occasionally with developmental hip dysplasia and children with PFFD. DIAGNOSIS: A hint for diagnosis is the limited range of internal rotation and an excess of external rotation of the hip besides some changes in the projection of femur and acetabulum. A CT in prone position with a summation of tomographic slices of the femoral neck and other details are necessary to measure AA and FA correctly. THERAPY: Therapy is indicated when pain occurs and osteoarthritis is developing. Decreased femoral anteversion is corrected by rotational osteotomies. Significant differences of acetabular anteversion are treated by rotation of the acetabulum after triple pelvic osteotomy. The normal value of acetabular and femoral anteversion to be achieved is 15 to 20 degrees.

Acetabulum↗
PubMedDate not supplied

[Osteoma cutis, a case report from the orthopedic viewpoint].

Osteoma cutis is a benign cutaneous disease which causes a primary heterotopic ossification of the skin. Corresponding to the appearance it is possible to distinguish four modifications. The enlargement of osteoma cutis can disturb the function of joints and statics. The etiology of the disease is unknown. Hamartoma or metaplasia is subject of discussion. It is important to mark off osteoma cutis from pseudohypoparathyreoidism (Albright-syndrome++).

Adult↗
PubMed1995

Reliability of measurements obtained with four tests for patellofemoral alignment.

BACKGROUND AND PURPOSE: A series of patellofemoral (PF) alignment tests have been described that are used to determine when and how PF taping techniques should be applied. The reliability of measurements obtained with these tests has not been reported. The purpose of this study was to determine the intertester reliability of measurements obtained with four PF alignment tests: medial/lateral displacement, medial/lateral tilt, medial/lateral rotation, and anterior tilt. SUBJECTS: Twelve physical therapists from four clinics served as testers. A total of 66 patients were evaluated. METHODS: Paired testers performed all four PF alignment tests on the same patient. The intertester reliability of judgments for each of the PF alignment tests was determined by a kappa correlation coefficient. RESULTS: Kappa correlation coefficients ranged from .10 to .36 for the four PF alignment tests. CONCLUSION AND DISCUSSION: These findings suggest that the reliability of measurements obtained with the PF alignment tests described in this report ranged from poor to fair. Potential factors affecting the reliability of these measurements are discussed. Alternative methods for deciding when and how to apply PF taping techniques are also discussed.

Adolescent↗
PubMed2001

Local factors in osteoarthritis.

Osteoarthritis is widely believed to be the result of local factors acting within the context of systemic susceptibility. Local factors, which are specific to joint site and in some instances specific to joint compartment, are receiving increasing attention in natural history studies of osteoarthritis. This review focuses on epidemiologic investigations dealing with these local factors. Local factors may be further characterized as extrinsic or intrinsic to the joint organ. In the past, the epidemiologic literature has emphasized the extrinsic category, factors and events that have an origin external to the joint and its immediate environment--for example, physical activity and injury. In recent years, intrinsic factors such as alignment, strength, laxity, and proprioception have begun to receive more attention. Ultimately, epidemiologic studies aid the development of strategies to prevent disease development or modify its course. Such strategies may be especially powerful for local factors, given the vicious cycles set in motion by these factors and the effect of these factors on neighboring joint-organ structures.

Bone Malalignment↗
PubMed1997

Meniscal allograft transplantation for unicompartmental arthritis of the knee.

Sixty-seven meniscal allografts were transplanted in the knees of 63 patients between 1988 and 1994. Before surgery, all patients experienced refractory disabling knee pain secondary to a prior total meniscectomy with advanced unicompartmental osteoarthritic changes as verified by arthroscopy. At a mean followup of 31 months (range, 1.0-5.5 years), 58 knees (86.6%) attained a good to excellent results-Twenty-one knees received isolated meniscal allografts, with 19 achieving good to excellent results (90.5%). Five knees received a medial or lateral meniscal allograft with an anterior cruciate ligament reconstruction, and 4 (80.0%) obtained good to excellent results. Thirty-four knees received a meniscal allograft in combination with either a valgus high tibial osteotomy, varus high tibial osteotomy, or varus distal femoral osteotomy to correct for preoperative varus or valgus deformities, with 29 (85.3%) attaining good to excellent results. The remaining 7 knees underwent a combined medial meniscal allograft, valgus high tibial osteotomy, and anterior cruciate ligament reconstruction with 6 (85.7%) attaining good to excellent results. The most frequent complication was a traumatic posterior horn tear in 6 knees at a mean of 21 months after surgery (range, 9-43 months), most likely the consequence of unsuccessful healing of the posterior horn of the graft.

Activities of Daily Living↗
PubMed2000

Does axial limb rotation affect the alignment measurements in deformed limbs?

The long-term outcome of total knee arthroplasty and femoral or tibial osteotomy is related to the ability of the surgeon to achieve the desired alignment based on preoperative planning. This study evaluates the effect of axial rotation on measured tibiofemoral angles and the angle formed between the anatomic and mechanical axes of the femur in lower extremities with valgus and varus deformities. A comparison study of the measured tibiofemoral angles indicated a statistically significant effect in models with severe vagus or varus deformity when rotated 10 degrees internally or externally. In the second part of the study, the measured angle between the anatomic and mechanical axes of the femur never varied by more than 1 degree, despite a 40 degrees are of rotation. The results of the study indicate the tibiofemoral angle measurements are more sensitive to axial limb rotation in lower extremities with valgus or varus deformity than are normally aligned limbs. In preoperative planning of total knee arthroplasty, the measured angle between the anatomic and mechanical axes of the femur is less effected by limb rotation, regardless of the degree of valgus or varus deformity.

Arthroplasty, Replacement, Knee↗
PubMed2001

Linear and volumetric wear of tibial inserts in posterior cruciate-retaining knee arthroplasties.

Linear and volumetric wear was measured in 33 tibial polyethylene inserts from three different cruciate-retaining knee systems retrieved at the time of revision surgery. Wear patterns also were evaluated and classified. Eccentric and asymmetric wear patterns were seen in 78% of inserts with flat articulating geometry versus 12% in inserts with curved anteroposterior geometry. The mean linear wear rate was .35 mm/year (range, .05-1.68 mm/year) and the mean volumetric wear rate was 794 mm3/year (range, 24-4088 mm3/year). Linear and volumetric wear rates showed a negative correlation with the length of implantation. Linear wear rates also showed a negative correlation with patient weight.

Arthroplasty, Replacement, Knee↗