Results with the M. E. Müller cemented, straight-stem total hip prosthesis: a 10-year historical cohort study in 180 women.

In 1986, 242 M. E. Muller (MEM) cemented, straight-stem total hip arthroplasty prostheses were implanted in 229 patients; 15 hips (13 patients) were lost to follow-up. Of the remaining 227 implants, 180 were placed in women, and 47 were placed in men (each with mean age, 71 +/- 7.7 years). After 10 years, 66 patients had died, and 152 implants were still in situ. As a result of aseptic loosening, 9 hips were revised (5 femoral and 4 acetabular components); two of these patients had a Girdlestone as a result of postoperative infection. Because 50% of the men died during follow-up, further analysis was performed with the 180 implants in women. The incidence of revision for aseptic loosening was 5.9 per 1,000 implants. The cumulative survival rate after 10 years was 94%. Survival was not influenced significantly by age, indication for operation, or having a contralateral hip prosthesis. The 10-year follow-up results for the MEM straight-stem total hip prosthesis in our hospital are satisfactory despite the probability that the cement mantle produced with this stem is not uniform in thickness.

The myth of the second prophylactic antibiotic dose in aortoiliac reconstructions.

OBJECTIVES: To determine whether a prophylactic second dose of antibiotics is justified when severe blood loss and/or prolonged operation time occurs during aortoiliac reconstructions. METHODS: We measured the cefuroxime concentration in venous blood serum and subcutaneous fat tissue of 30 patients who underwent elective aortoiliac reconstruction after a single intravenous dose of 1500 mg cefuroxime. RESULTS: The mean blood loss was 1912 ml (range 200-7000). The mean operation time was 212 min (range 70-330). The cefuroxime concentration in blood serum 30 min after the gift varied from 53.7-561.6 mg/l and during closure of the abdominal incision from 13.2-90.0 mg/l. Taking the minimum inhibitory concentration for Staphylococcus species as 1.0 mg/l, we found an adequate prophylactic serum cefuroxime concentration in all patients. There was a statistically significant correlation between serum cefuroxime concentration and blood loss (p = 0.01) and operation time (p = 0.0001). CONCLUSIONS: Although serum concentration of cefuroxime is greatly influenced by blood loss and operation time, a second dose of cefuroxime in aortoiliac reconstructions is not necessary if the operation is completed within 5.5 h and if perioperative blood loss does not exceed 7000 ml.