Porous titanium granules are better than autograft bone as a bone void filler in lateral tibial plateau fractures: A randomised trial.

A total of 20 patients with a depressed fracture of the lateral tibial plateau (Schatzker II or III) who would undergo open reduction and internal fixation were randomised to have the metaphyseal void in the bone filled with either porous titanium granules or autograft bone. Radiographs were undertaken within one week, after six weeks, three months, six months, and after 12 months. The primary outcome measure was recurrent depression of the joint surface: a secondary outcome was the duration of surgery. The risk of recurrent depression of the joint surface was lower (p < 0.001) and the operating time less (p < 0.002) when titanium granules were used. The indication is that it is therefore beneficial to use porous titanium granules than autograft bone to fill the void created by reducing a depressed fracture of the lateral tibial plateau. There is no donor site morbidity, the operating time is shorter and the risk of recurrent depression of the articular surface is less.

A lateral skin incision reduces peripatellar dysaesthesia after knee surgery.

In a series of 64 ligamentous injuries of the knee, 33 were explored through a medial incision and 31 through a long lateral incision. Sensibility of the skin, the occurrence of neuromas, and discomfort during kneeling were evaluated three and six years postoperatively. The lateral incisions produced less dysaesthesia, fewer neuromas and less discomfort on kneeling.

Early loosening of femoral components after cemented revision. A roentgen stereophotogrammetric study.

Roentgen stereophotogrammetric analysis was used to measure the migration of 24 cemented femoral components implanted during revision for mechanical loosening. All hips were examined one week, four months and one year after surgery; 14 hips were also examined after two years. Twenty-one components subsided 0.2 to 5.5 mm during the observation period; in 17 of these, subsidence occurred within four months of surgery. In 16 hips the prosthetic head was displaced 0.7 to 11.2 mm posteriorly. The fixation of the femoral components was less secure than after primary arthroplasty, especially in cases of femoral canal enlargement, when a standard-sized rather than a thick-stemmed prosthesis had been used, and in cases of inadequate cement filling.

Mechanical loosening of total hip prostheses. A radiographic and roentgen stereophotogrammetric study.

Twenty patients were examined by standard radiography and roentgen stereophotogrammetric analysis (RSA) during a two-year period after total hip arthroplasty. Eleven of the acetabular components migrated cranially and three femoral components migrated distally. This migration was most rapid during the first four months after operation. Our findings support the possibility that mechanical loosening is initiated by thermal injury during polymerisation of the cement; the less frequent migration of the metallic femoral component compared with the polyethylene acetabular component may be because the metal acts as a heat sink. Standard radiographs were inadequate for assessment of early mechanical loosening, whereas RSA could reveal migration within four months of the arthroplasty.

Loosening of the cemented hip prosthesis. The importance of heat injury.

The cemented hip arthroplasty is one of the most successful orthopedic operations. However, the results do deteriorate with time because of mechanical loosening. Some hips with obviously loose prosthetic components are not painful. This discrepancy between symptoms and radiographic evidence of loosening has caused uncertainty about the diagnostic criteria that should be applied. This uncertainty has in turn led to confusion about the basic cause of loosening. The aims of this presentation were to find a favorable definition of loosening and to investigate the etiology of mechanical loosening of the cemented hip prosthesis. The diagnostic criteria of contrast and radionuclide arthrography, bone scintigraphy, and roentgen stereophotogrammetric analysis (RSA) were evaluated in 14 symptomatic hip arthroplasties examined by these methods. Loosening was found to be best defined as migration; regardless of diagnostic criterion, all loose prosthetic components were migrating, but no nonmigrating component was loose. The development of the radiolucent zone was analyzed in a simple model consisting of 6 cases of giant-cell tumor of bone successfully treated by curettage and cementing. In locations where the cement filling adjacent to cancellous bone was concave, a considerably wider zone developed. There was a positive correlation between the width of the zone and the volume of cement. The radiolucent zone in this model could be explained by heat injury during the polymerization of bone cement. The pattern of migration of the components in 20 cemented hip prostheses was studied with RSA and with conventional radiography over a period of 2 years postoperatively. Eleven acetabular and three femoral components migrated. After an initial 4-month period of rapid migration, most components migrated slowly. The initial rapid migration could be accounted for by the resorption of a layer of necrotic bone following heat injury during the polymerization. The less frequent migration of the metallic femoral component as compared with the polyethylene acetabular component could be explained by the metal acting as a heat sink. Radiographic examination was found to be unsatisfactory as a means of detecting mechanical loosening during the first 2 postoperative years. RSA, on the other hand, was capable of revealing migration as early as 4 months postoperatively. Migration of the components in 16 hip prostheses was studied with RSA for 1 year postoperatively following randomized use of low- and high-viscosity cement. As regards prosthetic migration, no difference was detected between the two types of cement; low-viscosity cement did not improve prosthetic fixation.(ABSTRACT TRUNCATED AT 400 WORDS)

Posterior angulation in trochanteric fractures detected with roentgen stereophotogrammetry.

Roentgen stereophotogrammetric analysis has been carried out in 8 patients with trochanteric fracture after fixation with a sliding screw-plate. In 6 of the 8 cases the proximal fragment angulated posteriorly after the operation. Posterior angulation may be an important mode of failure of trochanteric fractures.

Accuracy of the Nunn method in measuring acetabular cup migration.

The accuracy of the Nunn method in measuring acetabular component migration was compared with 3 other radiological methods and with roentgen stereophotogrammetry in 34 pelvic radiographs. The Nunn method seems to have the same or better accuracy than the other non-computerized methods, but less accuracy than the computerized EBRA method.

Measurement accuracy of aluminium content in bone.

The aluminium content in bone has been related in several ways: to the weight of wet bone, to the weight of dry bone, to the weight of bone-ash and to the calcium content of bone. We determined the accuracy and precision of measurement (using an inductively coupled mass-spectrometer) in 30 bone samples taken from one patient. The coefficient of variation of the aluminium/weight-quotient was 12.4 per cent for wet bone, 4.7 for dry bone and 5.0 for bone ash; and the coefficient of variation of the aluminium/calcium-weight-quotient was 7.5 per cent. Thus, the aluminium content in bone seems to be best related to the weight of dry bone.

The theory of early loosening of hip prostheses.

The issue of prosthetic loosening is currently a matter of debate, particularly with regard to the timing and nature of the precipitating events. The theory presented here postulates that loosening begins at an early stage due to either insufficient initial fixation or early loss of fixation. The loosened prosthetic component is then affected by varying degrees of mechanical stress associated with normal daily activity, which differs according to patient characteristics (body weight and level of physical activity) and the components used (prosthetic design, positioning, friction, and wear). This theory of early loosening can explain without supplementary ad hoc assumptions the rapid early prosthetic migration detected by roentgen stereophotogrammetry, the development of focal osteolysis and wear granulomas, the phenomenon known as stress-shielding, and, to a great extent, the epidemiology of clinical failure.

Fixation and loosening of hip prostheses. A review.

Studies using roentgen stereophotogrammetry and bone scintigraphy support a narrow definition of prosthetic fixation (viz., nonmigration), and consequently a broad definition of loosening. Roentgen stereophotogrammetric research indicates that if loosening occurs, it is initiated at an early stage; insufficient initial fixation or loss of fixation by resorption of a layer of heat-injured bone may cause prosthetic instability and progressive bone resorption. Migration of one or both prosthetic components can be revealed by roentgen stereophotogrammetry in many asymptomatic hips during the first postoperative year--some of these components will probably fail in the future. The femoral component is exposed to greater shear stresses than the acetabular component, and it is uncertain whether fixation of the femoral component can be achieved more than occasionally without the use of bone cement.

Theories of wear and loosening in hip prostheses. Wear-induced loosening vs loosening-induced wear--a review.

The observation of perioprosthetic granulomas containing wear debris around apparently well-fixed as well as around loose-fitting prosthetic components has led to the development of the hypothesis of wear-induced loosening. However, the hypothesis of wear-induced loosening can neither explain the rapid early prosthetic migration detected by roentgen stereophotogrammetry nor the epidemiology of clinical failure without supplementary ad hoc-assumptions. By contrast, apart from explaining the rapid early prosthetic migration detected by roentgen stereophotogrammetry, the theory of early loosening can explain the development of wear granulomas as well as to a great extent the epidemiology of clinical failure.

Wrist joint tamponade after scaphoid fracture. A case report.

A scaphoid fracture was associated with high intraarticular pressure due to hemarthrosis. Scaphoid and lunate necrosis might be caused by wrist joint tamponade.

Arthrosis after surgically treated acetabular fractures. A retrospective study of 60 cases.

59 patients with 60 surgically treated acetabular fractures were followed up to 25 years. Coxarthrosis developed within 3 years in 23 fractured hips. There was a high correlation between nonanatomic reduction and posttraumatic arthrosis. The long-term results after an acetabular fracture can be predicted within 2-3 years of surgery.

Wear and loosening of the hip prosthesis. A roentgen stereophotogrammetric 3-year study of 14 cases.

Fourteen patients were followed by roentgen stereophotogrammetry for 3 years after hip arthroplasty. In 11 of the 14 acetabular components, definite wear was identified. The mean wear rate was 0.13 mm per year. There was no correlation between the wear and loosening of either the acetabular or the femoral component. Our findings indicate that products of wear do not initiate prosthetic loosening.