The vaginal pessary: an effective yet underused tool for incontinence and prolapse.
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Equipment Design↗
SEARCH · PubMed Health
Results for “Prosthesis Fitting”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
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Disposal fees and extended warranties: milking the cash cow.
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Dentist-Patient Relations↗
How close does an uncemented hip stem match the final rasp position?
During total hip arthroplasty the final clinical position of the cementless CLS stem (Centerpulse) is not always identical to the position of the final rasp with which a successful trial reduction was performed. Therefore, the rasp-stem correspondence of CLS system (Centerpulse) was investigated in a laboratory study and compared to the CBC-T system (Mathys). Both systems showed an average rasp-stem mismatch below 2 mm in three orthogonal directions. It was found that this mismatch related to geometric differences at the corners between rasp and stem. The measured mismatch is not expected to have adverse clinical consequences.
Arthroplasty, Replacement, Hip↗
Reliability of preoperative templating in total knee arthroplasty.
The purpose of this study was to determine the reliability of preoperative templating in primary total knee arthroplasty and the influence of the seniority of the surgeon on templating. A retrospective study of 25 randomly selected total knee replacements was undertaken, with templating of preoperative radiographs by four surgical staff members. These included a consultant, a specialist registrar and two senior house officers. Reliability for an exact match between template size and implant actually used was 49% for the femoral component and 67% for the tibial component. The statistical agreement between templated size and actual implant size was classed as only fair to moderate. There was no statistical difference in templating reliability between junior and senior surgical staff. These results indicate that the current system of templating for total knee arthoplasties is prone to error and can only be used as an approximate guide.
Aged↗
The Denham prosthesis in revision knee surgery: a 10 year follow-up.
We studied the Denham knee prosthesis (Biomet, Warsaw, IN) in revision of total knee arthroplasty (TKA) in situations of extreme bone loss or ligamentous disruption including revision from previous hinged implants. We reviewed 34 patients (38 knees) at an average of 7. 5 years after surgery (range 4-12 years). No patient was lost to follow-up although 15 unrelated deaths occurred during the study. There were six failures, of which five were due to infections in patients who received a revision for infection. A further two patients experienced a poor result. The remaining 30 patients had an excellent or good result. In our setting, the Denham TKA effectively addressed problems of loss of bone stock and ligamentous disruption with simple instrumentation and a remarkably small number of implants.
Aged↗
Minimally invasive total knee replacement using a mini-mid vastus incision technique and results.
This study was performed to determine whether differences existed between primary knee replacement performed through a standard medial parapatellar approach, and those performed through a minimally invasive mini-mid vastus approach. It was a prospective study compared with a retrospective evaluation of a matched cohort. In this study, the Genesis(tm) II and its MIS instrumentation were used. Patients with the mini-mid vastus MIS incision (MMV MIS) required less pain medication post-operatively, regained their flexion more rapidly, and attained their functional milestones at an earlier point than those with the traditional median parapatellar long incision. Despite the smaller incision, component placement was radiographically excellent in all cases. Optimal performance of the surgery required the use of special instrumentation, modified so as to be used in smaller incisions.
Arthroplasty, Replacement, Knee↗
Femoral head diameter in subcapital fracture of the femur in Ibadan, Nigeria.
Subcapital fracture of the femur is common in the elderly patients though the incidence is less in our environment than in the western world. Primary prosthetic replacement is the method of treatment in the majority of the patients. To facilitate this, a foreknowledge of the femoral head diameter is necessary. To determine the diameter of the femoral head and its magnification on radiograph among patients with hip fractures seen in South-West Nigeria, all patients with subcapital fracture of the neck of femur seen between March 1997 and February 2002 were included in the study. The femoral heads were measured on the radiographic film using a transparent ruler and after extraction of the femoral head during surgery using callipers. There were 25 patients in all, the mean age of patients was 73.2 years. Fall at home accounted for 70% of the cases. The femoral head diameter was between 42 mm and 50 mm in 92% of patients while magnification of femoral head diameter on radiograph was 10-14% in 92% of cases. The usaof 10-14% magnification of femoral head on radiograph would help the surgeon determine the size of prosthetic head before commencement of surgery.
Accidental Falls↗
Analysis of stiffness reduction in varying curvature ankle foot orthoses.
Ankle foot orthoses (AFO) are often used for patients who cannot generate a strong enough extension moment at the knee to allow functional gait. Orthotists often cut out portions of the AFO around the malleoli in order to improve comfort. There has been some question as to how this affects the stress distribution around the orthosis, the fatigue performance of the device, and the AFOs stiffness. To examine this, three orthoses were constructed with differing curvatures cut out of the malleolar regions. Photoelastic coatings were placed on the most stiff and least stiff orthoses, and the stress distributions while wearing the device were examined. A fixture was created to test the orthosis, and the stress distribution while loaded in the fixture closely matched the distribution with actual wear. These orthoses were then tested in fatigue for 500,000 cycles at 5 Hz in displacement control. Initial displacements were set to provide maximum loads of 45 lbs. The displacement settings for the stiffest orthosis were 0.4 to 0.6 inches of deflection; the load decreased from 44 lbs to 28 lbs after the final cycle. The least stiff displacement varied from 1.3 to 1.5 inches, and the load value changed from 46 lbs to 35 lbs. The data will be useful in guiding orthotists in building AFOs, particularly when shaving portions of the AFO for comfort. Excessive shaving may seriously degrade the performance of the device, especially after longer life cycles.
Ankle↗
Humeral component modularity may not be an important factor in the outcome of shoulder arthroplasty for glenohumeral osteoarthritis.
We examined the outcomes of using 3 types of humeral prostheses in total shoulder arthroplasty for osteoarthritis: a modular prosthesis with variable head diameters (MV), a nonmodular prosthesis with variable head diameters (NV), and a nonmodular prosthesis with a fixed head diameter (NF). Patients (N=101) completed self-assessments of shoulder function and health status before surgery and at follow-up between 30 and 60 months after surgery. Outcomes for the MV and NV prostheses did not differ statistically. The NF prosthesis trended toward poorer functional scores. Two Short Form-36 dimensions were statistically significantly lower (P<.05) in the NF group than in the MV and NV groups. These results fail to confirm that humeral component modularity is an important factor in the outcome of shoulder arthroplasty.
Aged↗
Simultaneous bilateral total hip arthroplasty with a cementless femoral stem.
Simultaneous bilateral total hip arthroplasty (THA) is an increasingly common procedure. Although use of a cementless stem can eliminate cement complications, some surgeons limit application of cementless THA because of concerns about early implant loosening. In this article, we report on 30 cementless THA cases (15 patients) followed up for a minimum of 2 years (range, 26-50 months). Despite 73% of femoral bone being type B or type C, all stems showed stable bone ingrowth fixation and no evidence of subsidence. Polyethylene wear rates (left, 0.154 mm/y; right, 0.114 mm/y) did not differ significantly. The excellent clinical results obtained with simultaneous bilateral cementless THA are comparable with those obtained with unilateral THA.
Aged↗
[The choices of health care system in orthopedics].
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Adolescent↗
[Chest wall reconstruction with a prosthetic material molded from a extirpated specimen].
A new molding technique of the Acryl-resin Marlex-mesh sandwich method is described. After the wide extirpation of the chest wall, the defect size tends to grow up more larger than the specimen. For making a just fit size prosthesis, we cut off a cardboard as the same size as the specimen and the Acryl-resin Marlex sandwich is molded from the cardboard. Other some know-how are in the text.
Acrylic Resins↗
The radiological outcomes of total knee arthroplasty using computer assisted navigation ORTHOPILOT.
Comprehensive radiographic analysis of total knee arthroplasty performed traditionally and with the use of Computer Assisted Navigation (CAN) is presented. The aim of this study was to compare the precision of implant alignment considering two operating techniques. The analyzed material consisted of 100 radiograms of patients operated on traditional way and 100 knee joint radiograms of patients operated on with a use of CAN. Assessment of postoperative radiograms was carried out in order to analyze coronal mechanical axis and sagittal orientation of both femoral and tibial components. Measurements were taken precisely up to 1 degrees and therefore results were classified as good (0-2 degrees deviation due to mechanical axis), satisfactory (2-4 degrees) and poor (over 4 degrees). The radiological outcome allows to present the following conclusions: CAN allows to minimize the risk of incorrect prosthesis alignment and therefore significantly improves the radiological outcome of total knee arthroplasty. This improvement can lead to better long time "survival" of implant components. The only price one pays for this improvement is 15-20 minute surgery delay, however it needs further studies to determine other possible disadvantages.
Arthroplasty, Replacement, Knee↗
[Protein C congenital deficiency. A case report].
Protein C is a plasmatic protein that is synthesized by the liver with the help of vitamin K. It regulates thrombin formation and consequently prevents thrombosis. We present a case of a newborn male with change in the color of the right foot index finger who after 4 h showed cyanosis that reached malleolus level. Upon admission we observed generalized pallor, tachycardia and a necrotic lesion in the rightfoot. We suspected a septic process and thus administered cefotaxime, vancomycin and heparin. Platelet levels were 70,000 mm3, thromboplastin 16/12 sec., partial thromboplastin 5829 sec. PCfunctionality 20% and protein S 100%. Even though the patient evolvedfavourably and showed partial recovery, an intratuberous amputation was needed. One year later a prosthesis was fitted. We need to carry out studies that support the use of PC monoclonal antibodies in order to offer better baseline treatment to patients with PC congenital deficiency and improve their quality of live.
Foot↗
Results with Kudo elbow prostheses in non-traumatic indications : a study of 36 cases.
With a mean follow-up of 62 months, we reviewed 13 Kudo type 4 and 23 Kudo type 5 elbow prostheses implanted for non-traumatic indications in 30 patients. Clinical results were assessed with the Mayo Clinic Performance Index (MCPI) taking into account pain, mobility, stability and daily activities. Postoperatively, pain disappeared or decreased, ulnar nerve dysfunction was improved and the functional status was significantly improved. The average range of motion increased by 7.8 degrees in extension and by 11.5 degrees in flexion; pronation and supination remained unchanged. Clinically, 89% of patients scored poorly on the MCPI preoperatively, whereas 61% had excellent or good scores postoperatively. Twenty-two patients out of 30 were satisfied. There were two early prosthetic dislocations, and prosthetic instability, assessed clinically, was found in 6 cases (17%). The rate of loosening was 28% (10/36) and seven elbows were revised. Metallosis, loosening and instability were significantly correlated. The survival rate of 82% at 54 months (SD = 7) is lower than that reported for non-constrained and semi-constrained prostheses in the literature.
Adult↗
[Critical observations on teflon-piston operation based on personal experiences].
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Adult↗
Stentless bioprostheses in small aortic roots: impact of patient-prosthesis mismatch on survival and quality of life.
BACKGROUND AND AIM OF THE STUDY: Although stentless bioprostheses offer hemodynamic advantages, prosthetic valves of smaller size may provide less reduction of left ventricular hypertrophy and, therefore, affect survival and quality of life. METHODS: A total of 303 patients (mean age 75 +/- 7 years) who underwent aortic valve replacement with the stentless Freestyle bioprostheses were followed up. The impact of projected indexed effective orifice area (IEOA) on survival and quality of life (QoL) was determined multivariately by Cox regression and logistic regression analysis. RESULTS: Independent predictors of survival time were diabetes mellitus (p < 0.001), atrial fibrillation (p = 0.004), male gender (p = 0.015), peripheral vascular disease (p = 0.039), and patient-prosthesis mismatch (PPM, defined as projected IEOA < 0.75 cm2/m2) in patients with aortic regurgitation (p = 0.017). A history of congestive heart failure (p = 0.016), small body mass index (p = 0.01), age > 75 years (p = 0.002) and small projected IEOA (p = 0.016) were identified as predictors of impaired QoL. CONCLUSION: PPM and small projected IEOA were identified as independent risk factors for impaired mid-term survival and QoL. As the occurrence of PPM was rare in total root replacements, and the implantation procedure did not increase the operative risk in the present patient population, the recommendation is made to consider this implantation technique if a small projected IEOA is expected.
Activities of Daily Living↗